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schedule","standard_charge_dollar":156.1,"additional_payer_notes":"APC"},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":146.03,"additional_payer_notes":"APC"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":176.24,"additional_payer_notes":"APC"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105.74,"additional_payer_notes":"APC"},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"fee schedule","standard_charge_dollar":125.0},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":100.71,"additional_payer_notes":"APC"}]}]},{"description":"Ldct for lung ca screen","code_information":[{"code":"G0297","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.0,"maximum":225.0,"payers_information":[{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"fee schedule","standard_charge_dollar":225.0}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System With Mcc","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":205063.44,"maximum":358861.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":209164.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":353296.23},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":297341.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":358861.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":211215.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":215316.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":205063.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":82919.86,"maximum":145109.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84578.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":138222.08},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120233.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145109.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85407.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87065.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":82919.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":155314.31,"maximum":271800.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":158420.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":268802.86},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":225205.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":271800.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159973.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":163080.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":155314.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":482214.13,"10th_percentile":482214.13,"90th_percentile":482214.13,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":375535.51,"10th_percentile":375535.51,"90th_percentile":378865.6,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":220174.95,"10th_percentile":220174.95,"90th_percentile":220174.95,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":137280.86,"10th_percentile":137280.86,"90th_percentile":137280.86,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":101356.91,"maximum":177374.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":103384.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":177223.84},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":146967.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":177374.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104397.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106424.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":101356.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":161535.08,"10th_percentile":161535.08,"90th_percentile":161535.08,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":227284.9,"10th_percentile":227284.9,"90th_percentile":227284.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":59323.21,"10th_percentile":59323.21,"90th_percentile":59323.21,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":1043.68,"10th_percentile":1043.68,"90th_percentile":1043.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":75446.55,"maximum":133567.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76955.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":133567.31},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":109397.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":132031.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77709.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79218.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":75446.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33931.01,"maximum":60820.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34609.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":60820.63},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49199.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59379.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34948.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35627.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":33931.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":94762.42,"maximum":165834.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96657.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":163913.02},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":137405.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":165834.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":97605.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99500.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":94762.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41011.37,"maximum":71769.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41831.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":68244.93},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59466.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71769.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42241.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43061.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":41011.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52507.81,"maximum":100001.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53557.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":100001.76},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76136.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":91888.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54083.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55133.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":52507.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39910.1,"maximum":69842.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40708.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":67677.98},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57869.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69842.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41107.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41905.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":39910.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30850.36,"maximum":53988.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31467.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":51469.68},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44733.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53988.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31775.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32392.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":30850.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21087.42,"maximum":36902.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21509.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":33236.92},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30576.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36902.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21720.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22141.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":21087.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":87940.36,"maximum":164326.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89699.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":164326.95},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":127513.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":153895.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90578.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92337.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":87940.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43390.27,"maximum":75932.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44258.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":75704.36},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62915.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75932.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44691.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45559.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":43390.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39750.58,"maximum":75704.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40545.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":75704.36},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57638.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69563.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40943.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41738.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":39750.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":315987.91,"maximum":552978.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":322307.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":473005.83},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":458182.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":552978.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":325467.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":331787.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":315987.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52207.07,"maximum":99426.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53251.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":99426.02},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75700.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":91362.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53773.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54817.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":52207.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":57579.54,"maximum":101104.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58731.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":101104.3},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":83490.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":100764.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59306.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60458.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":57579.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38737.11,"maximum":69329.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39511.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":69329.92},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56168.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67789.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39899.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40673.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":38737.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23250.46,"maximum":44282.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23715.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":44282.44},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33713.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40688.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23947.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24412.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":23250.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41931.17,"maximum":73379.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42769.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":71555.08},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60800.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73379.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43189.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44027.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":41931.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":55017.03,"10th_percentile":55017.03,"90th_percentile":55017.03,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28625.13,"maximum":50093.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29197.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":47681.64},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41506.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50093.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29483.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30056.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":28625.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33270.24,"maximum":58222.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33935.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":56093.1},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48241.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58222.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34268.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34933.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":33270.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41686.78,"10th_percentile":41686.78,"90th_percentile":51272.34,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":79652.02,"10th_percentile":79652.02,"90th_percentile":79652.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44252.88,"10th_percentile":44252.88,"90th_percentile":44252.88,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44291.45,"10th_percentile":44291.45,"90th_percentile":44291.45,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":568.0,"10th_percentile":568.0,"90th_percentile":568.0},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46371.76,"10th_percentile":46371.76,"90th_percentile":46371.76,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22751.41,"maximum":39814.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23206.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":38362.06},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32989.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39814.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23433.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23888.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":22751.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18461.19,"maximum":32307.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18830.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":30951.55},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26768.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32307.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19015.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19384.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":18461.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43965.43,"maximum":76939.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44844.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":76251.25},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63749.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76939.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45284.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46163.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":43965.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":57772.0,"10th_percentile":57772.0,"90th_percentile":57772.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24964.21,"maximum":43687.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25463.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":42101.18},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36198.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43687.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25713.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26212.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":24964.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":78575.47,"10th_percentile":78575.47,"90th_percentile":78575.47},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16063.26,"maximum":28110.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16384.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":27911.08},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23291.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28110.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16545.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16866.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":16063.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32785.83,"maximum":57375.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33441.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":52559.69},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47539.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57375.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33769.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34425.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":32785.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15593.48,"maximum":27288.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15905.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":26785.96},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22610.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27288.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16061.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16373.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15593.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12168.18,"maximum":21294.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12411.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20011.39},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17643.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21294.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12533.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12776.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12168.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28323.65,"maximum":49566.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28890.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":48774.16},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41069.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49566.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29173.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29739.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":28323.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23370.46,"10th_percentile":23370.46,"90th_percentile":23370.46,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17492.36,"maximum":30611.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17842.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":28530.72},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25363.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30611.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18017.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18366.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":17492.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17922.46,"10th_percentile":17922.46,"90th_percentile":17922.46,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14216.34,"maximum":24878.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14500.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22991.65},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20613.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24878.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14642.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14927.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14216.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24089.77,"maximum":42157.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24571.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":41652.14},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34930.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42157.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24812.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25294.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":24089.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11873.29,"maximum":20778.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12110.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20208.32},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17216.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20778.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12229.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12466.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11873.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10176.64,"10th_percentile":10176.64,"90th_percentile":10176.64,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15789.87,"10th_percentile":15789.87,"90th_percentile":15789.87,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":46385.25,"10th_percentile":46385.25,"90th_percentile":46385.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8601.66,"maximum":15052.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8773.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14276.65},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12472.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15052.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8859.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9031.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8601.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11280.3,"10th_percentile":9495.96,"90th_percentile":13498.31,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":19899.36,"10th_percentile":19899.36,"90th_percentile":19899.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":69628.97,"10th_percentile":69628.97,"90th_percentile":69628.97},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11510.57,"10th_percentile":11510.57,"90th_percentile":11510.57,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11831.6,"10th_percentile":11405.52,"90th_percentile":13627.77,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11371.06,"10th_percentile":11371.06,"90th_percentile":11371.06,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28254.13,"maximum":49444.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28819.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":47310.37},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40968.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49444.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29101.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29666.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":28254.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36840.4,"10th_percentile":36840.4,"90th_percentile":36840.4,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16088.87,"maximum":28330.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16410.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":28330.03},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23328.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28155.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16571.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16893.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":16088.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":45448.41,"10th_percentile":45448.41,"90th_percentile":45448.41,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12642.36,"maximum":22124.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12895.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22044.64},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18331.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22124.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13021.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13274.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12642.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13254.09,"maximum":25241.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13519.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":25241.9},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19218.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23194.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13651.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13916.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13254.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":21308.23,"10th_percentile":21308.23,"90th_percentile":21308.23},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18979.5,"10th_percentile":18979.5,"90th_percentile":18979.5,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7165.25,"maximum":12539.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7308.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11556.03},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10389.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12539.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7380.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7523.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7165.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6949.62,"10th_percentile":6949.62,"90th_percentile":6949.62,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":269.19,"10th_percentile":269.19,"90th_percentile":269.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":9483.25,"10th_percentile":9483.25,"90th_percentile":9483.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11173.01,"maximum":19552.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11396.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18803.48},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16200.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19552.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11508.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11731.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11173.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15896.08,"10th_percentile":15896.08,"90th_percentile":15896.08,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":28086.12,"10th_percentile":26614.7,"90th_percentile":29223.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4710.05,"10th_percentile":4710.05,"90th_percentile":4710.05,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14812.97,"10th_percentile":14812.97,"90th_percentile":19739.23,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7460.87,"maximum":13683.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7610.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13683.36},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10818.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13056.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7684.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7833.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7460.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4968.14,"10th_percentile":4968.14,"90th_percentile":4968.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16999.16,"maximum":31408.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17339.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":31408.12},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24648.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29748.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17509.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17849.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":16999.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21710.78,"10th_percentile":21710.78,"90th_percentile":21710.78,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30585.91,"10th_percentile":30585.91,"90th_percentile":68356.49,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9480.49,"maximum":16741.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9670.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":16741.38},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13746.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16590.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9764.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9954.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9480.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14234.21,"10th_percentile":14234.21,"90th_percentile":29249.07,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":11402.0,"10th_percentile":5288.0,"90th_percentile":28883.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":61553.32,"10th_percentile":61553.32,"90th_percentile":61553.32},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23933.28,"10th_percentile":23933.28,"90th_percentile":48146.22,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42922.75,"10th_percentile":42922.75,"90th_percentile":44750.16,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":30877.08,"10th_percentile":30877.08,"90th_percentile":62457.3},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6060.24,"10th_percentile":6060.24,"90th_percentile":6060.24,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12509.18,"maximum":23150.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12759.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":23150.95},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18138.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21891.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12884.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13134.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12509.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":8693.81,"10th_percentile":8693.81,"90th_percentile":8693.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9080.22,"maximum":15890.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9261.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15346.58},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13166.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15890.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9352.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9534.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9080.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":11614.82,"10th_percentile":11614.82,"90th_percentile":11614.82,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":19974.05,"10th_percentile":19974.05,"90th_percentile":19974.05,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":33665.07,"10th_percentile":33665.07,"90th_percentile":35952.35},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13763.98,"10th_percentile":13763.98,"90th_percentile":13763.98,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":17102.36,"10th_percentile":17102.36,"90th_percentile":17102.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6730.59,"maximum":11778.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6865.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11193.53},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9759.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11778.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6932.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7067.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6730.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":12671.26,"10th_percentile":12671.26,"90th_percentile":12671.26,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":17243.5,"10th_percentile":17243.5,"90th_percentile":17243.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":10883.22,"10th_percentile":10883.22,"90th_percentile":10883.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11005.11,"10th_percentile":11005.11,"90th_percentile":11005.11,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":24710.78,"10th_percentile":24710.78,"90th_percentile":24710.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20174.94,"maximum":35306.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20578.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":33906.72},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29253.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35306.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20780.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21183.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":20174.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9703.76,"10th_percentile":9703.76,"90th_percentile":9703.76,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":56602.52,"10th_percentile":56602.52,"90th_percentile":56602.52},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33708.85,"10th_percentile":33708.85,"90th_percentile":33708.85,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12858.22,"maximum":22501.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13115.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22336.89},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18644.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22501.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13243.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13501.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12858.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16027.9,"10th_percentile":16027.9,"90th_percentile":16027.9,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21191.66,"10th_percentile":21191.66,"90th_percentile":21191.66,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":31402.46,"10th_percentile":31402.46,"90th_percentile":31879.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17637.22,"10th_percentile":17637.22,"90th_percentile":17637.22,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10272.23,"maximum":17976.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10477.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":17619.4},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14894.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17976.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10580.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10785.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10272.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14715.39,"maximum":25751.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15009.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":24949.64},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21337.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25751.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15156.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15451.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14715.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":47003.81,"10th_percentile":47003.81,"90th_percentile":47003.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":18040.95,"10th_percentile":8719.97,"90th_percentile":21968.98,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":567.62,"10th_percentile":567.62,"90th_percentile":567.62,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":35722.32,"10th_percentile":33547.68,"90th_percentile":45475.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":25085.84,"10th_percentile":25085.84,"90th_percentile":70791.02},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23277.16,"10th_percentile":23277.16,"90th_percentile":23277.16,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"21","median_amount":19232.23,"10th_percentile":18456.27,"90th_percentile":36863.65,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":50254.68,"10th_percentile":50254.68,"90th_percentile":50254.68},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":15887.23,"10th_percentile":15887.23,"90th_percentile":15887.23,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":29807.56,"10th_percentile":29807.56,"90th_percentile":29807.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7392.82,"maximum":12937.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7540.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12756.41},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10719.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12937.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7614.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7762.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7392.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":35411.52,"10th_percentile":35411.52,"90th_percentile":35411.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":8690.53,"10th_percentile":5925.52,"90th_percentile":10135.22,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":13251.53,"10th_percentile":12161.76,"90th_percentile":14424.24,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":18249.25,"10th_percentile":11851.75,"90th_percentile":24318.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"11","median_amount":21350.65,"10th_percentile":15050.88,"90th_percentile":30846.93},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8491.32,"10th_percentile":8491.32,"90th_percentile":8491.32,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9371.95,"10th_percentile":8658.89,"90th_percentile":11702.69,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10480.28,"10th_percentile":10480.28,"90th_percentile":10480.28,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":13101.74,"10th_percentile":8369.6,"90th_percentile":17006.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5008.06,"maximum":8764.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5108.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8633.47},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7261.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8764.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5158.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5258.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5008.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8260.24,"10th_percentile":8260.24,"90th_percentile":8260.24,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":14300.6,"10th_percentile":13495.72,"90th_percentile":14974.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":29667.45,"10th_percentile":29667.45,"90th_percentile":29667.45,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7101.45,"10th_percentile":7101.45,"90th_percentile":7101.45,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":39064.05,"10th_percentile":39064.05,"90th_percentile":39064.05},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10747.14,"maximum":18807.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10962.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18260.36},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15583.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18807.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11069.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11284.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10747.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6325.2,"maximum":11069.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6451.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11058.07},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9171.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11069.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6514.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6641.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6325.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":14034.9,"10th_percentile":14034.9,"90th_percentile":14034.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9581.34,"10th_percentile":9581.34,"90th_percentile":9581.34,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5845.18,"maximum":10229.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5962.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10037.05},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8475.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10229.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6020.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6137.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5845.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":167.53,"10th_percentile":167.53,"90th_percentile":6842.33,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":11275.5,"10th_percentile":11275.5,"90th_percentile":11275.5,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":15013.83,"10th_percentile":15013.83,"90th_percentile":15013.83,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":25876.75,"10th_percentile":17368.99,"90th_percentile":25904.43},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7821.51,"10th_percentile":7348.83,"90th_percentile":8941.84,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10672.53,"10th_percentile":10672.53,"90th_percentile":10672.53,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6639.37,"10th_percentile":6639.37,"90th_percentile":6639.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12182.09,"maximum":21808.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12425.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":21808.83},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17664.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21318.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12547.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12791.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12182.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11124.4,"10th_percentile":11124.4,"90th_percentile":11124.4,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16820.15,"10th_percentile":16820.15,"90th_percentile":17194.86,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7507.7,"maximum":13218.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7657.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13218.0},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10886.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13138.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7732.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7883.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7507.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9987.0,"10th_percentile":9987.0,"90th_percentile":9987.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":698.36,"10th_percentile":698.36,"90th_percentile":698.36,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":41268.62,"10th_percentile":41268.62,"90th_percentile":41268.62},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18660.8,"10th_percentile":18660.8,"90th_percentile":18660.8,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":22261.44,"10th_percentile":22261.44,"90th_percentile":22261.44},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5533.45,"maximum":9683.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5644.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9408.64},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8023.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9683.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5699.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5533.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11739.38,"maximum":20543.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11974.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19385.48},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17022.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20543.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12091.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12326.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11739.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15711.23,"10th_percentile":15711.23,"90th_percentile":15711.23,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":21438.54,"10th_percentile":21438.54,"90th_percentile":21438.54,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":172.63,"10th_percentile":172.63,"90th_percentile":172.63,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7542.83,"maximum":13199.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7693.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13075.01},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10937.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13199.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7769.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7919.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7542.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8484.97,"10th_percentile":8484.97,"90th_percentile":8484.97,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":16016.41,"10th_percentile":16016.41,"90th_percentile":16694.74,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":18468.89,"10th_percentile":293.3,"90th_percentile":19707.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":26954.13,"10th_percentile":26954.13,"90th_percentile":26954.13},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":23716.25,"10th_percentile":23716.25,"90th_percentile":23716.25,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10374.62,"10th_percentile":10374.62,"90th_percentile":12769.67,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5500.89,"10th_percentile":5493.54,"90th_percentile":5552.9,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14031.21,"maximum":24554.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14311.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":21604.37},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20345.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24554.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14452.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14732.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14031.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16152.53,"10th_percentile":16152.53,"90th_percentile":16152.53,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4971.03,"10th_percentile":4971.03,"90th_percentile":4971.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6038.36,"maximum":11500.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6159.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11500.84},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8755.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10567.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6219.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6340.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6038.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19394.26,"maximum":19394.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19394.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14998.91,"10th_percentile":14998.91,"90th_percentile":14998.91,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":22110.92,"10th_percentile":22110.92,"90th_percentile":22110.92,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12515.59,"maximum":12515.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12515.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8362.54,"maximum":8362.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8362.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13244.58,"maximum":24933.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13509.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":24933.33},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19204.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23178.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13641.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13906.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13244.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19334.72,"10th_percentile":19334.72,"90th_percentile":19334.72,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18996.1,"10th_percentile":18996.1,"90th_percentile":18996.1,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6553.51,"maximum":11468.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6684.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11349.07},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9502.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11468.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6750.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6881.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6553.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8680.91,"10th_percentile":8680.91,"90th_percentile":8680.91,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16724.76,"maximum":29268.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17059.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":29101.43},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24250.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29268.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17226.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17561.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":16724.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21836.83,"10th_percentile":21836.83,"90th_percentile":21836.83,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":76131.44,"10th_percentile":76131.44,"90th_percentile":76131.44},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22102.23,"10th_percentile":22102.23,"90th_percentile":22102.23,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10213.69,"maximum":17873.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10417.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":17438.78},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14809.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17873.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10520.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10724.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10213.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":26187.25,"10th_percentile":26187.25,"90th_percentile":26187.25},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6994.02,"maximum":12239.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7133.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11991.28},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10141.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12239.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7203.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7343.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6994.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16624.51,"maximum":29092.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16957.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":28421.59},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24105.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29092.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17123.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17455.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":16624.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9363.86,"10th_percentile":9363.86,"90th_percentile":9363.86,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21811.84,"10th_percentile":21573.45,"90th_percentile":22485.79,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9532.44,"maximum":16681.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9723.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":16451.63},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13822.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16681.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9818.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10009.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9532.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":289.88,"10th_percentile":289.88,"90th_percentile":289.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6693.27,"maximum":11713.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6827.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11088.17},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9705.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11713.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6894.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7027.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6693.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7242.85,"10th_percentile":7242.85,"90th_percentile":7242.85,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8690.64,"10th_percentile":8690.64,"90th_percentile":8690.64,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9891.73,"maximum":17693.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10089.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":17693.41},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14343.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17310.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10188.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10386.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9891.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14426.41,"10th_percentile":14426.41,"90th_percentile":14426.41,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8038.95,"maximum":14068.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8199.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13447.54},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11656.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14068.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8280.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8440.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8038.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":26030.19,"10th_percentile":26030.19,"90th_percentile":26030.19},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6023.72,"maximum":10752.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6144.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10752.01},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8734.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10541.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6204.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6324.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6023.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12850.9,"maximum":22863.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13107.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22863.71},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18633.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22489.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13236.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13493.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12850.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12983.2,"10th_percentile":12983.2,"90th_percentile":17956.84,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":32226.93,"10th_percentile":32226.93,"90th_percentile":32226.93,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":224.9,"10th_percentile":224.9,"90th_percentile":224.9},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20992.1,"10th_percentile":20992.1,"90th_percentile":20992.1,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19535.4,"10th_percentile":18531.77,"90th_percentile":21668.96,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21291.48,"10th_percentile":21291.48,"90th_percentile":21291.48,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7485.75,"maximum":13280.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7635.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13280.72},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10854.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13100.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7710.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7860.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7485.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10731.86,"10th_percentile":10731.86,"90th_percentile":10731.86,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":88.69,"10th_percentile":88.69,"90th_percentile":88.69,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":38308.61,"10th_percentile":38308.61,"90th_percentile":38308.61},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10917.6,"10th_percentile":10917.6,"90th_percentile":10917.6,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10533.07,"10th_percentile":10533.07,"90th_percentile":11160.09,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10583.19,"10th_percentile":10583.19,"90th_percentile":10583.19,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5826.88,"maximum":10197.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5943.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9900.33},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8448.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10197.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6001.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6118.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5826.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":167.53,"10th_percentile":167.53,"90th_percentile":167.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":13118.07,"10th_percentile":13118.07,"90th_percentile":13118.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7476.1,"10th_percentile":7476.1,"90th_percentile":7476.1,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25753.03,"maximum":45762.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26268.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":45762.54},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37341.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45067.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26525.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27040.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":25753.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34527.47,"10th_percentile":34527.47,"90th_percentile":34527.47,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":20559.35,"10th_percentile":20559.35,"90th_percentile":20559.35},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18873.16,"maximum":33028.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19250.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":30066.0},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27366.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33028.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19439.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19816.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":18873.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":43492.75,"10th_percentile":43492.75,"90th_percentile":43492.75,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18873.16,"maximum":33028.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19250.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":30066.0},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27366.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33028.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19439.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19816.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":18873.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":3966.0,"10th_percentile":3966.0,"90th_percentile":3966.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26429.16,"maximum":46251.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26957.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":44964.79},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38322.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46251.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27222.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27750.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":26429.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":740.19,"10th_percentile":740.19,"90th_percentile":740.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":224.9,"10th_percentile":224.9,"90th_percentile":224.9},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43574.0,"10th_percentile":43574.0,"90th_percentile":43574.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3617.03,"10th_percentile":3617.03,"90th_percentile":3617.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16792.81,"maximum":29387.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17128.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":27207.41},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24349.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29387.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17296.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17632.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":16792.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":10249.92,"10th_percentile":10249.92,"90th_percentile":10249.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":23570.19,"10th_percentile":23570.19,"90th_percentile":23570.19},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9969.29,"maximum":17475.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10168.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":17475.16},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14455.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17446.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10268.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10467.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9969.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14172.43,"maximum":24900.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14455.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":24900.72},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20550.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24801.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14597.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14881.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14172.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19283.91,"10th_percentile":337.85,"90th_percentile":20749.9,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":21927.0,"10th_percentile":21927.0,"90th_percentile":21927.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":28972.87,"10th_percentile":1528.43,"90th_percentile":35937.21,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":26435.91,"10th_percentile":26435.91,"90th_percentile":31602.54},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18841.37,"10th_percentile":18362.12,"90th_percentile":19380.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":30875.52,"10th_percentile":30875.52,"90th_percentile":30875.52},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20040.41,"10th_percentile":20040.41,"90th_percentile":20040.41,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6604.73,"maximum":11559.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6736.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11559.79},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9576.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11558.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6802.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6934.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6604.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2425.39,"10th_percentile":2425.39,"90th_percentile":2425.39,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":15902.82,"10th_percentile":15902.82,"90th_percentile":15902.82,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":16396.07,"10th_percentile":5067.94,"90th_percentile":21173.51,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":15943.1,"10th_percentile":12786.12,"90th_percentile":33393.96},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":172.63,"10th_percentile":172.63,"90th_percentile":172.63,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8961.75,"10th_percentile":8957.35,"90th_percentile":10033.7,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9345.15,"10th_percentile":9345.15,"90th_percentile":9345.15,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":5331.49,"10th_percentile":5331.49,"90th_percentile":5331.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8202.13,"maximum":14542.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8366.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14542.56},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11893.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14353.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8448.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8612.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8202.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":24332.74,"10th_percentile":24332.74,"90th_percentile":24332.74},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6119.58,"maximum":10709.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6241.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10664.21},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8873.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10709.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6303.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6425.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6119.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":16939.56,"10th_percentile":16939.56,"90th_percentile":16939.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":10941.81,"10th_percentile":9715.04,"90th_percentile":23284.73},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8505.43,"10th_percentile":8505.43,"90th_percentile":8995.45,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":6342.4,"10th_percentile":6342.4,"90th_percentile":6342.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17204.05,"maximum":30107.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17548.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":28304.94},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24945.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30107.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17720.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18064.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":17204.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4148.27,"10th_percentile":2736.02,"90th_percentile":4148.27,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9900.51,"maximum":17325.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10098.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14827.29},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14355.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17325.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10197.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10395.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9900.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11231.55,"maximum":19655.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11456.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19202.35},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16285.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19655.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11568.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11793.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11231.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4640.71,"10th_percentile":4640.71,"90th_percentile":4640.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13230.68,"maximum":23153.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13495.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20928.3},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19184.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23153.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13627.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13892.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13230.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7938.7,"maximum":13892.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8097.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13529.07},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11511.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13892.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8176.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8335.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7938.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8512.39,"maximum":14896.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8682.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14588.97},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12342.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14896.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8767.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8938.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8512.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":69989.74,"10th_percentile":69989.74,"90th_percentile":69989.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5750.05,"maximum":10062.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5865.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8508.04},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8337.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10062.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5922.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6037.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5750.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6740.4,"10th_percentile":6740.4,"90th_percentile":6740.4,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5843.71,"maximum":10226.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5960.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10074.68},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8473.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10226.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6019.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6135.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5843.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":202.05,"10th_percentile":202.05,"90th_percentile":202.05,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":22253.93,"10th_percentile":22253.93,"90th_percentile":22253.93},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8653.59,"10th_percentile":8653.59,"90th_percentile":8653.59,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9681.72,"maximum":16943.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9875.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":16353.8},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14038.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16943.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9972.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10165.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9681.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":17373.72,"10th_percentile":17373.72,"90th_percentile":17373.72,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5618.34,"maximum":10356.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5730.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10356.9},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8146.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9832.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5786.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5899.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5618.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8848.59,"10th_percentile":8848.59,"90th_percentile":8848.59,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":14341.96,"10th_percentile":14341.96,"90th_percentile":14341.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15878.86,"maximum":30240.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16196.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":30240.35},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23024.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27788.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16355.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16672.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15878.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23665.1,"10th_percentile":23665.1,"90th_percentile":23665.1,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7429.41,"maximum":13001.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7578.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12269.74},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10772.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13001.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7652.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7800.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7429.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10926.41,"maximum":19121.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11144.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":17541.64},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15843.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19121.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11254.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11472.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10926.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":57139.14,"10th_percentile":57139.14,"90th_percentile":57139.14},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6484.72,"maximum":11348.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6614.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10203.88},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9402.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11348.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6679.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6808.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6484.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3297.42,"10th_percentile":3297.42,"90th_percentile":3297.42,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3080.36,"10th_percentile":3080.36,"90th_percentile":3080.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2849.41,"10th_percentile":2849.41,"90th_percentile":2849.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9042.17,"maximum":17220.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9223.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":17220.53},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13111.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15823.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9313.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9494.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9042.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4151.31,"10th_percentile":4151.31,"90th_percentile":4151.31,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3871.99,"10th_percentile":3871.99,"90th_percentile":3871.99,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3887.97,"10th_percentile":3803.58,"90th_percentile":5963.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31211.11,"maximum":54619.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31835.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":53045.11},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45256.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54619.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32147.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32771.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":31211.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":8841.42,"10th_percentile":8841.42,"90th_percentile":8841.42,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":12710.0,"10th_percentile":12710.0,"90th_percentile":12710.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9908.24,"10th_percentile":9908.24,"90th_percentile":9908.24,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15960.09,"maximum":27930.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16279.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":26946.51},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23142.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27930.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16438.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16758.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15960.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"11","median_amount":3242.3,"10th_percentile":3204.41,"90th_percentile":6418.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11681.57,"maximum":20442.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11915.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19721.64},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16938.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20442.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12032.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12265.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11681.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27415.55,"maximum":47977.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27963.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":41413.82},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39752.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47977.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28238.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28786.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":27415.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":103639.63,"10th_percentile":103639.63,"90th_percentile":103639.63},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6669.35,"10th_percentile":6669.35,"90th_percentile":6669.35,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6616.36,"10th_percentile":4608.99,"90th_percentile":9929.33,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12680.41,"maximum":22190.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12934.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22033.35},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18386.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22190.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13060.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13314.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12680.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17814.44,"10th_percentile":17814.44,"90th_percentile":17814.44,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":196.68,"10th_percentile":196.68,"90th_percentile":196.68,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8797.77,"maximum":15396.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8973.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14859.91},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12756.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15396.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9061.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9237.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8797.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":12798.83,"10th_percentile":12798.83,"90th_percentile":12798.83,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1660.5,"10th_percentile":1660.5,"90th_percentile":1660.5,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15493.97,"maximum":28772.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15803.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":28772.8},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22466.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27114.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15958.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16268.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15493.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":35049.94,"10th_percentile":35049.94,"90th_percentile":35049.94,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9304.14,"maximum":16282.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9490.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15612.5},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13491.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16282.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9583.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9769.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9304.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5832.74,"maximum":10207.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5949.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10043.32},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8457.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10207.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6007.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6124.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5832.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5499.79,"maximum":9624.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5609.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9376.03},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7974.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9624.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5664.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5774.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5499.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6941.24,"10th_percentile":6941.24,"90th_percentile":6941.24,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":25459.62,"10th_percentile":25459.62,"90th_percentile":25459.62},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7399.41,"10th_percentile":6496.95,"90th_percentile":7642.13,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9743.18,"maximum":17335.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9938.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":17335.93},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14127.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17050.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10035.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10230.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9743.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14325.1,"10th_percentile":14325.1,"90th_percentile":14325.1,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5371.01,"maximum":9507.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5478.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9507.73},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7787.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9399.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5532.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5639.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5371.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":11311.0,"10th_percentile":11311.0,"90th_percentile":11311.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8650.69,"maximum":15138.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8823.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14232.75},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12543.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15138.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8910.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9083.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8650.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":5019.41,"10th_percentile":5019.41,"90th_percentile":5019.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5401.74,"maximum":9453.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5509.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8926.98},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7832.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9453.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5563.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5671.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5401.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":12658.54,"10th_percentile":12658.54,"90th_percentile":12658.54,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":8335.49,"10th_percentile":8335.49,"90th_percentile":8335.49,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11440.83,"maximum":20397.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11669.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20397.72},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16589.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20021.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11784.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12012.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11440.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6706.44,"maximum":11736.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6840.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11710.31},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9724.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11736.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6907.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7041.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6706.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5057.09,"maximum":8849.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5158.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8434.03},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7332.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8849.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5208.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5309.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5057.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":12973.83,"10th_percentile":12973.83,"90th_percentile":12973.83,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12562.6,"maximum":21984.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12813.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20538.2},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18215.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21984.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12939.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13190.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12562.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6657.41,"maximum":11796.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6790.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11796.86},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9653.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11650.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6857.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6990.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6657.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9354.75,"10th_percentile":9354.75,"90th_percentile":9354.75,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9686.08,"10th_percentile":9686.08,"90th_percentile":9686.08,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":7482.69,"10th_percentile":7482.69,"90th_percentile":7482.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5184.41,"maximum":9072.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5288.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8273.48},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7517.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9072.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5339.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5443.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5184.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":6378.42,"10th_percentile":6378.42,"90th_percentile":6378.42,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":44605.37,"10th_percentile":44605.37,"90th_percentile":44605.37},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32795.34,"maximum":57810.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33451.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":57810.26},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47553.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57391.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33779.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34435.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":32795.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44499.47,"10th_percentile":44499.47,"90th_percentile":44499.47,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":141083.94,"10th_percentile":141083.94,"90th_percentile":141083.94,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":80550.02,"10th_percentile":77800.89,"90th_percentile":81730.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":141260.45,"10th_percentile":35578.64,"90th_percentile":168448.2},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44547.0,"10th_percentile":44547.0,"90th_percentile":44547.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45948.8,"10th_percentile":45698.91,"90th_percentile":52871.61,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48229.58,"10th_percentile":48229.58,"90th_percentile":48229.58,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18469.24,"maximum":32321.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18838.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":31568.68},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26780.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32321.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19023.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19392.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":18469.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":37321.12,"10th_percentile":37321.12,"90th_percentile":37321.12,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47420.2,"10th_percentile":47420.2,"90th_percentile":47420.2,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":31748.42,"10th_percentile":31748.42,"90th_percentile":31748.42},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14007.06,"maximum":24512.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14287.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":23379.23},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20310.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24512.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14427.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14707.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14007.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27350.43,"maximum":48303.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27897.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":48303.79},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39658.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47863.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28170.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":27350.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37681.1,"10th_percentile":37681.1,"90th_percentile":37681.1,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":69049.12,"10th_percentile":69049.12,"90th_percentile":69049.12,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38143.55,"10th_percentile":38071.99,"90th_percentile":44560.5,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13773.72,"10th_percentile":13773.72,"90th_percentile":13773.72,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13196.29,"maximum":23093.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13460.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22917.64},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19134.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23093.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13592.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13856.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13196.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9998.56,"maximum":17497.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10198.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":16980.96},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14497.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17497.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10298.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10498.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9998.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21779.65,"maximum":38487.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22215.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":38487.49},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31580.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38114.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22433.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22868.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":21779.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10051.25,"maximum":17674.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10252.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":17674.59},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14574.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17589.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10352.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10553.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10051.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12012.38,"10th_percentile":167.53,"90th_percentile":26014.54,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":19348.06,"10th_percentile":19348.06,"90th_percentile":19348.06,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":29385.22,"10th_percentile":29385.22,"90th_percentile":29385.22,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":27144.63,"10th_percentile":21222.08,"90th_percentile":45576.65},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6813.01,"10th_percentile":6813.01,"90th_percentile":6813.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13344.94,"10th_percentile":12433.28,"90th_percentile":14544.56,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15176.31,"10th_percentile":15176.31,"90th_percentile":15176.31,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5890.55,"maximum":10308.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6008.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10216.42},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8541.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10308.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6067.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6185.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5890.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6647.77,"10th_percentile":6647.77,"90th_percentile":6647.77,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":312.63,"10th_percentile":312.63,"90th_percentile":312.63,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":15130.69,"10th_percentile":15130.69,"90th_percentile":15130.69,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":18562.0,"10th_percentile":18562.0,"90th_percentile":19200.24},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9760.97,"10th_percentile":9760.97,"90th_percentile":9760.97,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10720.93,"10th_percentile":10720.93,"90th_percentile":10720.93,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11434.98,"maximum":20276.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11663.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20276.05},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16580.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20011.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11778.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12006.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11434.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":14482.76,"10th_percentile":202.05,"90th_percentile":14965.31,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":26470.15,"10th_percentile":26470.15,"90th_percentile":26470.15,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":27408.03,"10th_percentile":27408.03,"90th_percentile":27408.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":9557.69,"10th_percentile":8792.21,"90th_percentile":20747.02},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16137.96,"10th_percentile":15426.52,"90th_percentile":16507.18,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15423.86,"10th_percentile":14975.62,"90th_percentile":16907.48,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7141.83,"maximum":12498.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7284.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12444.09},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10355.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12498.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7356.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7498.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7141.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11635.66,"10th_percentile":11635.66,"90th_percentile":11635.66,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":4904.25,"10th_percentile":4904.25,"90th_percentile":4904.25,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":17849.38,"10th_percentile":17849.38,"90th_percentile":17849.38,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":27213.6,"10th_percentile":27213.6,"90th_percentile":27213.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5524.67,"maximum":9668.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5635.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9654.49},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8010.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9668.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5690.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5800.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5524.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12922.61,"maximum":22614.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13181.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":21921.72},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18737.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22614.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13310.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13568.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12922.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15823.51,"10th_percentile":15823.51,"90th_percentile":15823.51,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":28393.38,"10th_percentile":28393.38,"90th_percentile":28393.38},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16124.97,"10th_percentile":1329.06,"90th_percentile":17417.74,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7836.99,"maximum":13925.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7993.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13925.44},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11363.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13714.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8072.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8228.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7836.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11609.88,"10th_percentile":11609.88,"90th_percentile":11609.88,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10506.85,"10th_percentile":10506.85,"90th_percentile":10506.85,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5515.89,"maximum":10504.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5626.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10504.91},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7998.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9652.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5681.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5791.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5515.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":30812.54,"10th_percentile":30812.54,"90th_percentile":30812.54,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11194.96,"maximum":19908.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11418.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19908.54},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16232.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19591.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11530.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11754.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11194.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14770.93,"10th_percentile":14770.93,"90th_percentile":14770.93,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":27563.53,"10th_percentile":27563.53,"90th_percentile":27563.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7786.5,"maximum":13626.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7942.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13396.12},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11290.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13626.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8020.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8175.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7786.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9392.57,"10th_percentile":9392.57,"90th_percentile":9392.57,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5755.17,"maximum":10071.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5870.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9753.58},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8345.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10071.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5927.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6042.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5755.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":21556.02,"10th_percentile":21556.02,"90th_percentile":21556.02},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11404.24,"maximum":19957.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11632.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19818.22},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16536.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19957.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11746.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11974.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11404.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8312.95,"10th_percentile":8312.95,"90th_percentile":13807.32,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":28909.64,"10th_percentile":28909.64,"90th_percentile":28909.64,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7237.69,"maximum":12665.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7382.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12592.1},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10494.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12665.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7454.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7599.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7237.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":971.91,"10th_percentile":971.91,"90th_percentile":971.91,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":18718.39,"10th_percentile":18718.39,"90th_percentile":18718.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11359.53,"10th_percentile":11359.53,"90th_percentile":11359.53,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5248.07,"maximum":9207.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5353.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9207.95},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7609.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9184.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5405.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5510.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5248.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9039.98,"maximum":15819.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9220.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15522.19},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13107.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15819.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9311.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9491.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9039.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":22032.43,"10th_percentile":22032.43,"90th_percentile":22032.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":10577.48,"10th_percentile":9626.31,"90th_percentile":15354.12,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":4303.9,"10th_percentile":4303.9,"90th_percentile":17595.96,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":941.6,"10th_percentile":941.6,"90th_percentile":941.6,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":20672.28,"10th_percentile":20293.45,"90th_percentile":22292.38,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":16944.59,"10th_percentile":16944.59,"90th_percentile":16944.59,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":15877.55,"10th_percentile":7995.38,"90th_percentile":58582.23},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":14583.54,"10th_percentile":14583.54,"90th_percentile":14583.54,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12096.06,"10th_percentile":12096.06,"90th_percentile":12096.06,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"44","median_amount":13017.27,"10th_percentile":10868.31,"90th_percentile":15332.09,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":30030.8,"10th_percentile":30030.8,"90th_percentile":30030.8},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13068.98,"10th_percentile":12728.82,"90th_percentile":13068.98,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":15489.28,"10th_percentile":15489.28,"90th_percentile":15489.28,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":65192.9,"10th_percentile":65192.9,"90th_percentile":65192.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8105.54,"maximum":14184.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8267.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14089.75},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11753.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14184.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8348.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8510.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8105.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":8981.82,"10th_percentile":7229.38,"90th_percentile":11037.18,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":19023.96,"10th_percentile":18202.87,"90th_percentile":19987.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":10033.69,"10th_percentile":10033.69,"90th_percentile":10033.69},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11071.69,"10th_percentile":11071.69,"90th_percentile":13159.47,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":10968.19,"10th_percentile":10121.16,"90th_percentile":12090.78,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6168.61,"maximum":10795.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6291.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10775.85},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8944.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10795.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6353.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6477.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6168.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7972.98,"10th_percentile":7972.98,"90th_percentile":8561.58,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":18764.05,"10th_percentile":18764.05,"90th_percentile":18764.05,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8619.65,"10th_percentile":8409.83,"90th_percentile":8971.62,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9164.06,"10th_percentile":9164.06,"90th_percentile":9164.06,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":6274.5,"10th_percentile":6274.5,"90th_percentile":6274.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4697.8,"maximum":8221.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4791.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8117.95},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6811.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8221.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4838.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4932.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4697.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7185.43,"10th_percentile":7185.43,"90th_percentile":7892.57,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9618.05,"maximum":16831.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9810.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":16529.4},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13946.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16831.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9906.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10098.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9618.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":11273.73,"10th_percentile":190.97,"90th_percentile":13737.71,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":20707.18,"10th_percentile":20524.62,"90th_percentile":86566.49,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16079.25,"10th_percentile":16079.25,"90th_percentile":16079.25,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":20391.22,"10th_percentile":20391.22,"90th_percentile":23372.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"14","median_amount":16172.18,"10th_percentile":7649.29,"90th_percentile":29327.83},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12098.12,"10th_percentile":12098.12,"90th_percentile":13120.96,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":13612.5,"10th_percentile":11662.84,"90th_percentile":15488.81,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14139.67,"10th_percentile":14139.67,"90th_percentile":15708.51,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":22646.67,"10th_percentile":22646.67,"90th_percentile":22646.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5897.13,"maximum":10319.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6015.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10285.41},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8550.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10319.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6074.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6191.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5897.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6401.96,"10th_percentile":6401.96,"90th_percentile":7759.17,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":10728.18,"10th_percentile":4980.24,"90th_percentile":12886.08,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":10210.71,"10th_percentile":10210.71,"90th_percentile":15383.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":11074.97,"10th_percentile":11074.97,"90th_percentile":11074.97,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":10324.72,"10th_percentile":10324.72,"90th_percentile":10788.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8557.42,"10th_percentile":6812.96,"90th_percentile":9818.46,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8874.93,"10th_percentile":8874.93,"90th_percentile":8874.93,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":9951.92,"10th_percentile":9951.92,"90th_percentile":9951.92,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":6030.81,"10th_percentile":6030.81,"90th_percentile":6030.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4599.02,"maximum":8048.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4691.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":7811.89},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6668.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8048.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4736.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4828.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4599.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":4874.31,"10th_percentile":4874.31,"90th_percentile":4874.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":17153.03,"10th_percentile":17153.03,"90th_percentile":17153.03},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":11982.92,"10th_percentile":11982.92,"90th_percentile":11982.92,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7092.84,"10th_percentile":7092.84,"90th_percentile":7092.84,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":9728.3,"10th_percentile":9728.3,"90th_percentile":9728.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13809.49,"maximum":24166.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14085.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":23633.86},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20023.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24166.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14223.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14499.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13809.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20877.89,"10th_percentile":20877.89,"90th_percentile":20877.89,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6944.99,"maximum":12416.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7083.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12416.49},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10070.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12153.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7153.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7292.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6944.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5240.76,"maximum":9171.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5345.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8785.24},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7599.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9171.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5397.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5502.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5240.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12908.71,"maximum":22590.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13166.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22141.22},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18717.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22590.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13295.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13554.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12908.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16733.59,"10th_percentile":16733.59,"90th_percentile":16733.59,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":29794.11,"10th_percentile":29794.11,"90th_percentile":31083.82,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16523.54,"10th_percentile":16523.54,"90th_percentile":16523.54,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18498.76,"10th_percentile":18498.76,"90th_percentile":19680.58,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17860.02,"10th_percentile":17860.02,"90th_percentile":17860.02,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8044.07,"maximum":14077.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8204.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13890.32},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11663.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14077.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8285.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8446.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8044.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":167.53,"10th_percentile":167.53,"90th_percentile":167.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":23431.38,"10th_percentile":23431.38,"90th_percentile":23431.38,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10705.08,"10th_percentile":10705.08,"90th_percentile":10705.08,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5232.71,"maximum":9157.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5337.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8490.48},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7587.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9157.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5389.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5494.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5232.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6747.66,"10th_percentile":6747.66,"90th_percentile":6747.66,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7106.71,"maximum":12436.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12125.49},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10304.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12436.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7319.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7462.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7106.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8251.65,"10th_percentile":202.05,"90th_percentile":9812.03,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":14321.49,"10th_percentile":12781.88,"90th_percentile":15275.34,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":17378.62,"10th_percentile":16229.55,"90th_percentile":17645.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":19751.18,"10th_percentile":12937.29,"90th_percentile":32149.77},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9391.65,"10th_percentile":9391.65,"90th_percentile":9391.65,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":17626.87,"10th_percentile":17626.87,"90th_percentile":17626.87},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":13362.67,"10th_percentile":13362.67,"90th_percentile":13362.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4902.69,"maximum":8733.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8733.82},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7108.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8579.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5049.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5147.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4902.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":9473.87,"10th_percentile":9473.87,"90th_percentile":9473.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":7694.06,"10th_percentile":7694.06,"90th_percentile":7694.06,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":4092.0,"10th_percentile":4092.0,"90th_percentile":4092.0},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5908.11,"maximum":10339.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6026.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10171.26},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8566.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10339.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6085.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6203.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5908.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46.09,"10th_percentile":46.09,"90th_percentile":46.09,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":177.2,"10th_percentile":177.2,"90th_percentile":177.2,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":17522.88,"10th_percentile":17522.88,"90th_percentile":17522.88},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7614.28,"10th_percentile":7614.28,"90th_percentile":7614.28,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":49822.22,"10th_percentile":49822.22,"90th_percentile":49822.22},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":177.2,"10th_percentile":177.2,"90th_percentile":177.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13398.25,"maximum":23677.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13666.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":23677.76},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19427.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23446.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13800.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14068.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13398.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6967.95,"10th_percentile":6967.95,"90th_percentile":6967.95,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":27226.92,"10th_percentile":27226.92,"90th_percentile":27226.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20022.24,"10th_percentile":20022.24,"90th_percentile":20022.24,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6886.45,"maximum":12051.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11361.61},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9985.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12051.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7093.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7230.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6886.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13904.38,"10th_percentile":13904.38,"90th_percentile":13904.38,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":16369.34,"10th_percentile":16369.34,"90th_percentile":16369.34,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47085.59,"maximum":82399.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48027.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":81125.53},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":68274.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":82399.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48498.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49439.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":47085.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62196.68,"10th_percentile":400.77,"90th_percentile":93041.89,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":53865.2,"10th_percentile":53865.2,"90th_percentile":53865.2,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":64494.84,"10th_percentile":64494.84,"90th_percentile":64494.84,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":64961.12,"10th_percentile":64961.12,"90th_percentile":64961.12,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20113.47,"maximum":35198.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20515.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":33667.15},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29164.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35198.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20716.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21119.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":20113.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":25141.43,"10th_percentile":758.28,"90th_percentile":30772.22,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":57842.07,"10th_percentile":57842.07,"90th_percentile":57842.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":141531.44,"10th_percentile":141531.44,"90th_percentile":141531.44},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25892.21,"10th_percentile":25892.21,"90th_percentile":25892.21,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26572.27,"10th_percentile":26002.85,"90th_percentile":69777.7,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":39625.0,"10th_percentile":39625.0,"90th_percentile":39625.0,"additional_payer_notes":"Contracting method is an algorithm described in 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":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":79570.67,"maximum":139248.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81162.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":136634.11},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":115377.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":139248.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81957.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83549.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":79570.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":72859.83,"maximum":132884.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74317.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":132884.96},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":105646.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":127504.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75045.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76502.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":72859.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":114781.92,"10th_percentile":114781.92,"90th_percentile":114781.92,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":71585.13,"maximum":125273.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73016.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":121046.7},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":103798.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":125273.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73732.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75164.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":71585.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":92329.45,"10th_percentile":92329.45,"90th_percentile":92329.45,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48114.42,"maximum":84200.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49076.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":80996.33},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69765.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":84200.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49557.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50520.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":48114.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48114.42,"maximum":84200.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49076.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":74620.63},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69765.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":84200.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49557.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50520.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":48114.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":56185.56,"maximum":98324.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57309.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":97046.58},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":81469.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":98324.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57871.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58994.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":56185.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":135200.81,"10th_percentile":135200.81,"90th_percentile":135200.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39022.49,"maximum":68289.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39802.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":66432.44},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56582.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":68289.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40193.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40973.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":39022.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":115756.07,"10th_percentile":115756.07,"90th_percentile":115756.07},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":382.62,"10th_percentile":382.62,"90th_percentile":382.62},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36881.4,"maximum":64542.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37619.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":57602.05},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53478.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64542.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37987.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38725.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":36881.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":178051.27,"10th_percentile":178051.27,"90th_percentile":178051.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36202.34,"maximum":63354.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36926.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":62501.41},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52493.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63354.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37288.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38012.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":36202.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48629.84,"10th_percentile":48629.84,"90th_percentile":48629.84,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":101210.9,"10th_percentile":101210.9,"90th_percentile":101210.9,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":293.3,"10th_percentile":293.3,"90th_percentile":293.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51543.21,"10th_percentile":51543.21,"90th_percentile":51543.21,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23046.3,"maximum":40331.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23507.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":38960.37},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33417.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40331.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23737.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24198.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":23046.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30991.3,"10th_percentile":30991.3,"90th_percentile":30991.3,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":61685.36,"maximum":107949.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62919.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":106283.38},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":89443.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":107949.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63535.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64769.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":61685.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":316345.76,"10th_percentile":316345.76,"90th_percentile":316345.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":14222.75,"10th_percentile":14222.75,"90th_percentile":14222.75,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44362.76,"maximum":77634.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45250.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":76617.51},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64326.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77634.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45693.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46580.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":44362.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55943.36,"maximum":98034.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57062.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":98034.99},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":81117.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":97900.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57621.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58740.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":55943.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":76143.24,"10th_percentile":76143.24,"90th_percentile":87699.73,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":136676.73,"10th_percentile":136676.73,"90th_percentile":136676.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":195235.29,"10th_percentile":195235.29,"90th_percentile":195235.29},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":91277.17,"10th_percentile":91277.17,"90th_percentile":91277.17,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":10182.69,"10th_percentile":10182.69,"90th_percentile":10182.69,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39973.03,"maximum":69952.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40772.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":66728.46},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57960.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69952.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41172.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41971.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":39973.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50873.28,"10th_percentile":50873.28,"90th_percentile":51778.5,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":169789.51,"10th_percentile":169789.51,"90th_percentile":169789.51,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":93595.79,"10th_percentile":93595.79,"90th_percentile":93595.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":119097.37,"10th_percentile":119097.37,"90th_percentile":119097.37},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":65082.17,"10th_percentile":65082.17,"90th_percentile":65082.17,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42943.18,"maximum":75150.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43802.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":73801.56},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62267.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75150.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44231.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45090.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":42943.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":193307.91,"10th_percentile":193307.91,"90th_percentile":193307.91},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30651.33,"maximum":53639.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31264.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":51575.05},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44444.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53639.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31570.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32183.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":30651.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":146467.04,"10th_percentile":146467.04,"90th_percentile":146467.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49070.82,"10th_percentile":49070.82,"90th_percentile":49070.82,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":161550.34,"10th_percentile":161550.34,"90th_percentile":161550.34},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40563.71,"10th_percentile":40563.71,"90th_percentile":42331.26,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36014.29,"maximum":63173.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36734.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":63173.73},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52220.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63025.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37094.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37815.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":36014.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47732.25,"10th_percentile":47732.25,"90th_percentile":57858.62,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":89804.41,"10th_percentile":89804.41,"90th_percentile":89804.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51199.37,"10th_percentile":51199.37,"90th_percentile":51681.14,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":34902.81,"10th_percentile":34902.81,"90th_percentile":34902.81},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50327.03,"10th_percentile":50327.03,"90th_percentile":50327.03,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20858.39,"maximum":36525.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21275.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":36525.74},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30244.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36502.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21484.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21901.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":20858.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26499.33,"10th_percentile":26499.33,"90th_percentile":26499.33,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":159984.74,"10th_percentile":159984.74,"90th_percentile":159984.74,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":52713.05,"10th_percentile":52713.05,"90th_percentile":52713.05,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":28726.83,"10th_percentile":28726.83,"90th_percentile":28726.83},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":16048.66,"10th_percentile":16048.66,"90th_percentile":16048.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28023.67,"10th_percentile":28023.67,"90th_percentile":28023.67,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28014.44,"10th_percentile":28014.44,"90th_percentile":28014.44,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":8988.0,"10th_percentile":8988.0,"90th_percentile":8988.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10130.28,"maximum":18937.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10332.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18937.69},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14688.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17727.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10434.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10636.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10130.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6708.82,"10th_percentile":6708.82,"90th_percentile":6708.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23363.15,"maximum":42546.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23830.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":42546.47},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33876.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40885.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24064.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24531.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":23363.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33808.73,"10th_percentile":33808.73,"90th_percentile":33808.73,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15592.75,"maximum":28256.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15904.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":28256.02},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22609.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27287.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16060.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16372.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15592.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22362.32,"10th_percentile":22362.32,"90th_percentile":22362.32,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13226.29,"maximum":23146.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13490.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22636.68},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19178.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23146.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13623.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13887.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13226.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6879.72,"10th_percentile":6879.72,"90th_percentile":6879.72,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33385.13,"maximum":61292.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34052.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":61292.25},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48408.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58423.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34386.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35054.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":33385.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":87839.7,"10th_percentile":87839.7,"90th_percentile":87839.7,"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":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15970.33,"maximum":29008.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16289.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":29008.61},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23156.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27948.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16449.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16768.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15970.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15898.51,"10th_percentile":15898.51,"90th_percentile":15898.51,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10935.93,"maximum":19598.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11154.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19598.72},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15857.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19137.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11264.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11482.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10935.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":105.94,"10th_percentile":105.94,"90th_percentile":105.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":53174.22,"10th_percentile":53174.22,"90th_percentile":53174.22},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25525.46,"maximum":44669.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26035.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":43025.62},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37011.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44669.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26291.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26801.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":25525.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33327.79,"10th_percentile":32000.86,"90th_percentile":34501.98,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":293.3,"10th_percentile":293.3,"90th_percentile":293.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":26894.07,"10th_percentile":26894.07,"90th_percentile":26894.07},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33258.8,"10th_percentile":33258.8,"90th_percentile":33258.8,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34092.11,"10th_percentile":34092.11,"90th_percentile":43200.54,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18993.17,"maximum":33238.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19373.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":32021.48},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27540.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33238.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19562.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19942.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":18993.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":141196.12,"10th_percentile":141196.12,"90th_percentile":141196.12,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24182.6,"10th_percentile":24182.6,"90th_percentile":24182.6,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24567.37,"10th_percentile":24567.37,"90th_percentile":24567.37,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6891.2,"10th_percentile":6891.2,"90th_percentile":6891.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":233.6,"10th_percentile":233.6,"90th_percentile":233.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13037.5,"maximum":22815.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13298.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":21941.78},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18904.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22815.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13428.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13689.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13037.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16594.97,"10th_percentile":16594.97,"90th_percentile":16594.97,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":36556.86,"10th_percentile":36556.86,"90th_percentile":36556.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":12951.53,"10th_percentile":12951.53,"90th_percentile":12951.53,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18138.08,"10th_percentile":18138.08,"90th_percentile":18138.08,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4105.96,"10th_percentile":4105.96,"90th_percentile":4105.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19738.09,"maximum":34541.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20132.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":32816.72},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28620.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34541.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20330.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20724.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":19738.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24461.42,"10th_percentile":24461.42,"90th_percentile":24461.42,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25691.13,"10th_percentile":25691.13,"90th_percentile":25691.13,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12424.3,"maximum":21742.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12672.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":21243.13},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18015.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21742.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12797.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13045.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12424.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18315.8,"10th_percentile":18315.8,"90th_percentile":18315.8,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7992.12,"maximum":13986.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8151.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11187.26},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11588.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13986.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8231.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8391.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7992.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22992.15,"maximum":40236.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23451.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":35188.64},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33338.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40236.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23681.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24141.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":22992.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14796.61,"maximum":25894.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15092.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22045.89},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21455.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25894.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15240.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15536.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14796.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23802.2,"maximum":42732.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24278.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":42732.11},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34513.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41653.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24516.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24992.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":23802.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":202.05,"10th_percentile":202.05,"90th_percentile":202.05,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13833.64,"maximum":24208.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14110.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":23799.43},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20058.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24208.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14248.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14525.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13833.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11926.71,"maximum":20871.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12165.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19036.78},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17293.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20871.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12284.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12523.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11926.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":28564.94,"10th_percentile":28564.94,"90th_percentile":28564.94,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22372.37,"maximum":39151.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22819.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":33639.55},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32439.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39151.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23043.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23490.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":22372.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":177.2,"10th_percentile":177.2,"90th_percentile":177.2,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":8182.65,"10th_percentile":8182.65,"90th_percentile":8182.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24444.67,"maximum":43837.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24933.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":43837.16},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35444.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42778.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25178.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25666.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":24444.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32077.0,"10th_percentile":32077.0,"90th_percentile":32077.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":84013.14,"10th_percentile":84013.14,"90th_percentile":84013.14},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34211.24,"10th_percentile":33296.03,"90th_percentile":42177.6,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":68572.19,"10th_percentile":68572.19,"90th_percentile":68572.19,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26475.99,"maximum":46332.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27005.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":44740.27},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38390.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46332.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27270.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27799.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":26475.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44844.25,"maximum":78477.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45741.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":75138.67},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":65024.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78477.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46189.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47086.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":44844.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":68563.75,"10th_percentile":68563.75,"90th_percentile":68563.75,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":84602.69,"10th_percentile":84602.69,"90th_percentile":84602.69,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34836.91,"maximum":60964.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35533.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":59008.14},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50513.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60964.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35882.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36578.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":34836.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53994.91,"10th_percentile":53994.91,"90th_percentile":60193.39,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50328.68,"maximum":88075.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51335.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":83627.89},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":72976.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":88075.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51838.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52845.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":50328.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39752.93,"10th_percentile":39752.93,"90th_percentile":39752.93,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":67999.47,"10th_percentile":67999.47,"90th_percentile":67999.47,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30903.05,"maximum":54080.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31521.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":52184.65},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44809.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54080.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31830.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32448.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":30903.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40835.12,"10th_percentile":40835.12,"90th_percentile":40835.12,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":72318.94,"10th_percentile":72318.94,"90th_percentile":72318.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42003.5,"10th_percentile":42003.5,"90th_percentile":42003.5,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":157374.39,"10th_percentile":157374.39,"90th_percentile":157374.39,"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":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38609.05,"maximum":67565.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39381.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":64381.63},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55983.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67565.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39767.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40539.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":38609.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":59773.4,"10th_percentile":59773.4,"90th_percentile":61810.63,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":175177.24,"10th_percentile":175177.24,"90th_percentile":175177.24},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51161.23,"10th_percentile":51161.23,"90th_percentile":51161.23,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26023.04,"maximum":45540.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26543.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":43203.73},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37733.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45540.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26803.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27324.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":26023.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30075.34,"10th_percentile":202.05,"90th_percentile":40052.02,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":50151.98,"10th_percentile":50151.98,"90th_percentile":50151.98},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33963.49,"10th_percentile":33963.49,"90th_percentile":33963.49,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":86794.04,"10th_percentile":86794.04,"90th_percentile":86794.04},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18681.45,"maximum":32692.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19055.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":31383.04},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27088.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32692.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19241.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19615.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":18681.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30188.13,"maximum":52829.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30791.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":49043.83},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43772.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52829.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31093.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31697.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":30188.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38355.99,"10th_percentile":36331.21,"90th_percentile":42371.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":67389.67,"10th_percentile":67389.67,"90th_percentile":67389.67,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":80222.46,"10th_percentile":80222.46,"90th_percentile":80222.46},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":68257.77,"10th_percentile":68257.77,"90th_percentile":68257.77,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24086.84,"maximum":42151.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24568.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":39144.76},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34925.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42151.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24809.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25291.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":24086.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29133.6,"10th_percentile":28681.29,"90th_percentile":30910.34,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31526.64,"10th_percentile":31526.64,"90th_percentile":31526.64,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30675.32,"10th_percentile":30675.32,"90th_percentile":31913.59,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":64938.11,"10th_percentile":64938.11,"90th_percentile":64938.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52176.33,"maximum":91308.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53219.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":88636.38},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75655.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":91308.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53741.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54785.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":52176.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43952.99,"maximum":77692.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44832.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":77692.46},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63731.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76917.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45271.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46150.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":43952.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62134.65,"10th_percentile":62134.65,"90th_percentile":62134.65,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33795.64,"maximum":59142.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34471.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":58353.38},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49003.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59142.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34809.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35485.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":33795.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44485.76,"10th_percentile":44485.76,"90th_percentile":44485.76,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40730.38,"maximum":71278.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41544.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":62752.28},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59059.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71278.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41952.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42766.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":40730.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":82218.21,"10th_percentile":82218.21,"90th_percentile":82218.21},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26389.65,"maximum":46181.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26917.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":40190.86},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38264.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46181.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27181.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27709.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":26389.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11737.92,"maximum":20589.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11972.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20589.63},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17019.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20541.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12090.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12324.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11737.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":11362.29,"10th_percentile":202.05,"90th_percentile":16131.02,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":22084.98,"10th_percentile":22084.98,"90th_percentile":22084.98,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":29127.41,"10th_percentile":29127.41,"90th_percentile":29778.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":39932.57,"10th_percentile":38206.09,"90th_percentile":41137.54},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16093.87,"10th_percentile":16093.87,"90th_percentile":16093.87,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17101.29,"10th_percentile":15466.55,"90th_percentile":19774.5,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31044.24,"10th_percentile":31044.24,"90th_percentile":31044.24,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":19277.27,"10th_percentile":14543.6,"90th_percentile":47588.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6725.47,"maximum":11769.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6859.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11562.3},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9751.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11769.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6927.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7061.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6725.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7817.36,"10th_percentile":7204.33,"90th_percentile":9021.86,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":478.88,"10th_percentile":478.88,"90th_percentile":478.88,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":14848.4,"10th_percentile":14806.91,"90th_percentile":17623.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":27449.77,"10th_percentile":21665.36,"90th_percentile":38412.53},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8606.89,"10th_percentile":8364.59,"90th_percentile":9364.46,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":38492.7,"10th_percentile":38492.7,"90th_percentile":38492.7},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5291.25,"maximum":9259.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5397.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9095.06},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7672.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9259.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5449.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5555.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5291.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5584.37,"10th_percentile":5584.37,"90th_percentile":5584.37,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":13871.92,"10th_percentile":13871.92,"90th_percentile":13871.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":29030.13,"10th_percentile":21474.66,"90th_percentile":42149.48},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":11491.6,"10th_percentile":11491.6,"90th_percentile":11491.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7769.13,"10th_percentile":7769.13,"90th_percentile":7769.13,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9700.41,"10th_percentile":9700.41,"90th_percentile":9700.41,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6022.69,"10th_percentile":6022.69,"90th_percentile":6022.69,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14494.4,"maximum":25365.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14784.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":24526.93},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21016.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25365.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14929.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15219.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14494.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17143.61,"10th_percentile":17143.61,"90th_percentile":17143.61,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20045.0,"10th_percentile":20045.0,"90th_percentile":20116.16,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3603.02,"10th_percentile":3603.02,"90th_percentile":3603.02,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5065.14,"maximum":9293.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5166.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9293.24},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7344.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8864.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5217.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5318.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5065.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5002.02,"10th_percentile":5002.02,"90th_percentile":5002.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4382.42,"maximum":7669.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4470.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":7040.49},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6354.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7669.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4513.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4601.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4382.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16192.05,"maximum":28336.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16515.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":27761.82},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23478.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28336.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16677.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17001.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":16192.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":281.86,"10th_percentile":281.86,"90th_percentile":281.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10670.93,"10th_percentile":10670.93,"90th_percentile":20311.29,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":25709.29,"10th_percentile":25709.29,"90th_percentile":25709.29,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":38906.43,"10th_percentile":38906.43,"90th_percentile":47647.22,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":28285.26,"10th_percentile":28285.26,"90th_percentile":28285.26},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22667.54,"10th_percentile":22438.63,"90th_percentile":23765.61,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":24407.2,"10th_percentile":24407.2,"90th_percentile":24407.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7830.4,"maximum":13703.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7987.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13667.05},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11354.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13703.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8065.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8221.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7830.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12535.97,"10th_percentile":12535.97,"90th_percentile":12535.97,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":16046.3,"10th_percentile":16046.3,"90th_percentile":16046.3,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":18253.32,"10th_percentile":18253.32,"90th_percentile":18253.32,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":29833.33,"10th_percentile":23856.88,"90th_percentile":34992.66},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25333.36,"10th_percentile":25333.36,"90th_percentile":25333.36,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11929.46,"10th_percentile":11929.46,"90th_percentile":11929.46,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":26575.03,"10th_percentile":26575.03,"90th_percentile":26575.03},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":26534.35,"10th_percentile":26534.35,"90th_percentile":27914.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19802.48,"maximum":34654.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20198.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":34259.19},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28713.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34654.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20396.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20792.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":19802.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12490.15,"maximum":21857.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12739.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19775.58},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18110.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21857.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12864.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13114.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12490.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6803.03,"maximum":12279.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6939.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12279.77},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9864.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11905.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7007.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7143.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6803.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9394.14,"maximum":16439.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9582.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":16367.6},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13621.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16439.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9675.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9863.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9394.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":8481.6,"10th_percentile":8481.6,"90th_percentile":8481.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"80","median_amount":11276.55,"10th_percentile":167.53,"90th_percentile":13167.82,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"15","median_amount":16161.14,"10th_percentile":251.4,"90th_percentile":18297.72,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21150.18,"10th_percentile":21150.18,"90th_percentile":21150.18,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"29","median_amount":20957.49,"10th_percentile":293.3,"90th_percentile":27265.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"18","median_amount":23605.0,"10th_percentile":10417.34,"90th_percentile":76193.97},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":13512.28,"10th_percentile":13512.28,"90th_percentile":13512.28,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12552.6,"10th_percentile":12552.6,"90th_percentile":13454.45,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"59","median_amount":12528.26,"10th_percentile":11528.74,"90th_percentile":14784.08,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13862.6,"10th_percentile":13529.17,"90th_percentile":26988.28,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":17253.78,"10th_percentile":5561.09,"90th_percentile":54444.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6212.51,"maximum":10871.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6336.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10803.44},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9008.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10871.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6398.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6523.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6212.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":369.58,"10th_percentile":369.58,"90th_percentile":369.58,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":12133.76,"10th_percentile":12133.76,"90th_percentile":12133.76,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":18197.14,"10th_percentile":18197.14,"90th_percentile":18197.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":11458.26,"10th_percentile":11458.26,"90th_percentile":11458.26},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9189.4,"10th_percentile":9189.4,"90th_percentile":9189.4,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19934.41,"10th_percentile":19934.41,"90th_percentile":19934.41,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4141.68,"maximum":7247.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4224.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":6886.21},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6005.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7247.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4265.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4348.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4141.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5646.03,"10th_percentile":5646.03,"90th_percentile":5646.03,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15401.77,"maximum":15401.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15401.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9906.6,"maximum":9906.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9906.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11429.12,"maximum":20549.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11657.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20549.49},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16572.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20000.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12000.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11429.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14943.44,"10th_percentile":14943.44,"90th_percentile":14943.44,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":28966.49,"10th_percentile":28966.49,"90th_percentile":31540.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15984.18,"10th_percentile":15984.18,"90th_percentile":15984.18,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4639.26,"maximum":8835.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4732.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8835.42},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6726.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8118.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4778.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4871.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4639.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":64823.85,"10th_percentile":64823.85,"90th_percentile":64823.85},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3330.17,"maximum":5827.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3396.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":5539.07},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4828.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5827.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3430.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3496.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":3330.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11947.2,"maximum":20907.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12186.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20291.1},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17323.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20907.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12305.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12544.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11947.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":30808.48,"10th_percentile":30605.91,"90th_percentile":35065.1,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":56890.48,"10th_percentile":56890.48,"90th_percentile":56890.48},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15926.51,"10th_percentile":15926.51,"90th_percentile":15926.51,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":21168.27,"10th_percentile":21168.27,"90th_percentile":21168.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7811.38,"maximum":13669.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7967.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13427.47},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11326.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13669.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8045.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7811.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8584.16,"10th_percentile":202.05,"90th_percentile":10688.6,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":376.85,"10th_percentile":376.85,"90th_percentile":376.85,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":18858.15,"10th_percentile":18858.15,"90th_percentile":18858.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":33937.79,"10th_percentile":33937.79,"90th_percentile":35556.93},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9759.14,"10th_percentile":9759.14,"90th_percentile":9759.14,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5266.37,"maximum":9216.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5371.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8947.05},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7636.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9216.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5424.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5529.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5266.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":293.3,"10th_percentile":293.3,"90th_percentile":293.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":24063.16,"10th_percentile":24063.16,"90th_percentile":24063.16},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":76.67,"10th_percentile":76.67,"90th_percentile":76.67,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8756.06,"maximum":15323.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8931.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14590.23},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12696.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15323.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9018.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9193.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8756.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":353.73,"10th_percentile":353.73,"90th_percentile":353.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4926.11,"maximum":8620.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5024.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8434.03},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7142.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8620.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5073.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5172.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4926.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5361.12,"10th_percentile":171.74,"90th_percentile":7301.25,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":1086.4,"10th_percentile":1086.4,"90th_percentile":1086.4,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":9704.6,"10th_percentile":9704.6,"90th_percentile":9704.6},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":172.63,"10th_percentile":172.63,"90th_percentile":172.63,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8871.64,"10th_percentile":8871.64,"90th_percentile":8871.64,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8707.76,"maximum":15238.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8881.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14735.73},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12626.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15238.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8968.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9143.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8707.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10275.99,"10th_percentile":9226.5,"90th_percentile":11630.39,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":16389.23,"10th_percentile":16389.23,"90th_percentile":16389.23,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11783.91,"10th_percentile":11783.91,"90th_percentile":11783.91,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12361.54,"10th_percentile":12191.28,"90th_percentile":12371.43,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14377.18,"10th_percentile":14377.18,"90th_percentile":14377.18,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5525.41,"maximum":9669.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5635.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9416.17},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8011.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9669.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5691.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5801.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5525.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":2215.95,"10th_percentile":2215.95,"90th_percentile":2215.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5937.56,"10th_percentile":5861.72,"90th_percentile":7400.95,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":8476.22,"10th_percentile":8476.22,"90th_percentile":8476.22,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5888.55,"10th_percentile":5888.55,"90th_percentile":5888.55,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":14312.64,"10th_percentile":353.73,"90th_percentile":14954.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":13047.77,"10th_percentile":13047.77,"90th_percentile":13047.77},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8014.63,"10th_percentile":8014.63,"90th_percentile":8014.63,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6921.32,"10th_percentile":6921.32,"90th_percentile":6921.32,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":12310.93,"10th_percentile":12310.93,"90th_percentile":12310.93},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8269.75,"10th_percentile":8269.75,"90th_percentile":8269.75,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11530.84,"maximum":20178.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11761.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18782.16},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16719.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20178.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11876.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12107.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11530.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":11848.3,"10th_percentile":11848.3,"90th_percentile":11848.3,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6682.29,"maximum":11694.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6815.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11618.75},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9689.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11694.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6882.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7016.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6682.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":6954.66,"10th_percentile":6954.66,"90th_percentile":6954.66},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9948.17,"10th_percentile":9948.17,"90th_percentile":9948.17,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8810.21,"maximum":15417.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8986.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15127.08},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12774.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15417.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9074.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9250.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8810.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":10620.54,"10th_percentile":202.05,"90th_percentile":12495.36,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":11388.86,"10th_percentile":11388.86,"90th_percentile":11388.86,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17622.75,"10th_percentile":17622.75,"90th_percentile":17622.75,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":25764.62,"10th_percentile":25764.62,"90th_percentile":25764.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":41099.4,"10th_percentile":41099.4,"90th_percentile":41099.4},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":172.63,"10th_percentile":172.63,"90th_percentile":172.63,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11865.72,"10th_percentile":11865.72,"90th_percentile":12485.21,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":2879.96,"10th_percentile":2879.96,"90th_percentile":2879.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5383.45,"maximum":9421.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5491.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9273.17},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7806.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9421.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5544.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5652.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5383.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":26844.61,"10th_percentile":26844.61,"90th_percentile":26844.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6571.34,"10th_percentile":6423.65,"90th_percentile":6896.33,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":560.02,"10th_percentile":560.02,"90th_percentile":560.02,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11088.94,"10th_percentile":11088.94,"90th_percentile":11088.94,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":219.97,"10th_percentile":219.97,"90th_percentile":7083.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":10811.09,"10th_percentile":9920.13,"90th_percentile":16588.39},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":237.97,"10th_percentile":237.97,"90th_percentile":237.97,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8109.89,"10th_percentile":6339.02,"90th_percentile":9059.28,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":23080.0,"10th_percentile":23080.0,"90th_percentile":45233.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4142.41,"maximum":7249.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4225.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":7017.91},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6006.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7249.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4266.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4349.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4142.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4890.37,"10th_percentile":317.46,"90th_percentile":6163.53,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6061.26,"10th_percentile":6061.26,"90th_percentile":6061.26,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":7979.98,"10th_percentile":7979.98,"90th_percentile":7979.98},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":5244.58,"10th_percentile":5244.58,"90th_percentile":5244.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5136.12,"maximum":8988.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5238.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8761.41},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7447.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8988.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5290.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5392.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5136.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6993.64,"10th_percentile":6993.64,"90th_percentile":8554.1,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6377.89,"maximum":11161.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6505.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10928.87},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9247.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11161.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6569.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6696.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6377.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8892.44,"10th_percentile":359.16,"90th_percentile":9484.87,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":595.85,"10th_percentile":595.85,"90th_percentile":595.85,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":14444.64,"10th_percentile":14444.64,"90th_percentile":16988.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":25642.81,"10th_percentile":21170.81,"90th_percentile":109749.19},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8223.42,"10th_percentile":8223.42,"90th_percentile":8223.42,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":8899.12,"10th_percentile":8010.64,"90th_percentile":9347.84,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9363.41,"10th_percentile":9363.41,"90th_percentile":9363.41,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":25600.75,"10th_percentile":25600.75,"90th_percentile":25600.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5268.56,"maximum":9219.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5373.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8947.05},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7639.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9219.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5426.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5531.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5268.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5595.79,"10th_percentile":5595.79,"90th_percentile":7124.77,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":753.7,"10th_percentile":753.7,"90th_percentile":753.7,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10452.38,"10th_percentile":10452.38,"90th_percentile":10452.38,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":4881.84,"10th_percentile":4881.84,"90th_percentile":4881.84,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":10894.8,"10th_percentile":10894.8,"90th_percentile":17215.71},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":172.63,"10th_percentile":172.63,"90th_percentile":172.63,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7643.95,"10th_percentile":179.31,"90th_percentile":8078.99,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15258.34,"maximum":27010.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15563.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":27010.48},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22124.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26702.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15716.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16021.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15258.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21217.1,"10th_percentile":297.71,"90th_percentile":24975.24,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":37268.03,"10th_percentile":37268.03,"90th_percentile":37268.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":15740.84,"10th_percentile":15740.84,"90th_percentile":15740.84,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20333.71,"10th_percentile":20333.71,"90th_percentile":20333.71,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":31449.67,"10th_percentile":31449.67,"90th_percentile":31449.67},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7048.9,"maximum":12335.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7189.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12070.3},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10220.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12335.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7260.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7401.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7048.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10075.61,"10th_percentile":10075.61,"90th_percentile":10075.61,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":23873.23,"10th_percentile":23873.23,"90th_percentile":23873.23},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":12406.14,"10th_percentile":12406.14,"90th_percentile":12406.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":465.3,"10th_percentile":465.3,"90th_percentile":465.3,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9345.65,"10th_percentile":9345.65,"90th_percentile":10174.16,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6855.68,"10th_percentile":6855.68,"90th_percentile":6855.68,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4991.23,"maximum":8734.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5091.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8561.97},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7237.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8734.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5140.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5240.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4991.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7179.12,"10th_percentile":7179.12,"90th_percentile":7179.12,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":20368.9,"10th_percentile":20368.9,"90th_percentile":20368.9,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48928.12,"maximum":85624.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49906.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":77592.11},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70945.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":85624.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50395.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51374.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":48928.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32657.04,"maximum":57149.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33310.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":55095.92},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47352.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57149.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33636.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34289.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":32657.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17600.66,"maximum":30801.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17952.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":29032.44},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25520.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30801.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18128.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18480.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":17600.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19909.31,"maximum":35706.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20307.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":35706.67},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28868.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34841.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20506.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20904.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":19909.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27308.69,"10th_percentile":17680.22,"90th_percentile":31094.2,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":86670.99,"10th_percentile":86670.99,"90th_percentile":86670.99,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39583.93,"10th_percentile":39583.93,"90th_percentile":39583.93,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":49048.07,"10th_percentile":49027.11,"90th_percentile":49360.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":45261.68,"10th_percentile":45261.68,"90th_percentile":57635.18},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27404.01,"10th_percentile":27404.01,"90th_percentile":28491.6,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":77033.85,"10th_percentile":77033.85,"90th_percentile":77033.85},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52989.88,"10th_percentile":52989.88,"90th_percentile":52989.88,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":63787.94,"10th_percentile":63787.94,"90th_percentile":63787.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12900.66,"maximum":22691.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13158.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22691.87},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18705.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22576.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13287.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13545.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12900.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20287.6,"10th_percentile":20287.6,"90th_percentile":20287.6,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":27712.39,"10th_percentile":25029.58,"90th_percentile":33687.02,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":37184.37,"10th_percentile":37184.37,"90th_percentile":37184.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"11","median_amount":52960.57,"10th_percentile":41909.88,"90th_percentile":69477.13},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20833.87,"10th_percentile":20833.87,"90th_percentile":21179.43,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18902.96,"10th_percentile":17365.41,"90th_percentile":20788.46,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":56078.22,"10th_percentile":56078.22,"90th_percentile":56078.22},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":57674.02,"10th_percentile":44117.02,"90th_percentile":72530.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31665.53,"maximum":55414.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32298.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":53423.91},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45915.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55414.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32615.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33248.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":31665.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23057.28,"maximum":40350.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23518.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":40075.46},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33433.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40350.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23749.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24210.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":23057.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32232.5,"10th_percentile":32232.5,"90th_percentile":32232.5,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":93536.3,"10th_percentile":93536.3,"90th_percentile":93536.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23491.94,"maximum":41110.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23961.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":35898.58},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34063.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41110.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24196.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24666.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":23491.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29423.18,"10th_percentile":29423.18,"90th_percentile":29423.18,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36495.04,"maximum":63866.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37224.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":63703.05},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52917.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63866.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37589.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38319.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":36495.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48840.27,"10th_percentile":48840.27,"90th_percentile":48840.27,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":91288.19,"10th_percentile":91288.19,"90th_percentile":91288.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":59643.11,"10th_percentile":59643.11,"90th_percentile":59643.11,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17885.31,"maximum":31299.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18243.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":30456.1},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25933.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31299.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18421.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18779.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":17885.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28633.22,"10th_percentile":28633.22,"90th_percentile":28633.22,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":43388.33,"10th_percentile":43388.33,"90th_percentile":43388.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":49636.8,"10th_percentile":49636.8,"90th_percentile":49636.8},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22972.99,"10th_percentile":22972.99,"90th_percentile":22972.99,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":52200.77,"10th_percentile":52200.77,"90th_percentile":52200.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11724.75,"maximum":20518.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11959.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19986.3},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17000.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20518.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12076.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12310.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11724.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":20811.32,"10th_percentile":20811.32,"90th_percentile":20811.32,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19577.59,"10th_percentile":19577.59,"90th_percentile":19577.59,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":65761.02,"10th_percentile":65761.02,"90th_percentile":65761.02},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":19505.07,"10th_percentile":19505.07,"90th_percentile":19505.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33634.65,"maximum":58860.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34307.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":57594.52},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48770.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58860.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34643.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35316.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":33634.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":64830.24,"10th_percentile":64830.24,"90th_percentile":64830.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43201.14,"10th_percentile":202.05,"90th_percentile":44528.31,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":140539.45,"10th_percentile":140539.45,"90th_percentile":140539.45,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":104186.57,"10th_percentile":98210.32,"90th_percentile":525666.56},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45673.61,"10th_percentile":45598.75,"90th_percentile":46735.66,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17541.39,"maximum":30697.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17892.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":29648.31},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25435.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30697.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18067.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18418.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":17541.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":39932.0,"10th_percentile":39932.0,"90th_percentile":39932.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15728.14,"10th_percentile":14334.67,"90th_percentile":23011.48,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":32224.04,"10th_percentile":32224.04,"90th_percentile":32224.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":50009.05,"10th_percentile":41793.12,"90th_percentile":50793.47,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":52355.27,"10th_percentile":50833.01,"90th_percentile":81390.97},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":58361.62,"10th_percentile":58361.62,"90th_percentile":71924.8,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23280.38,"10th_percentile":23280.38,"90th_percentile":23280.38,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22306.9,"10th_percentile":22277.0,"90th_percentile":24573.6,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12314.53,"maximum":21550.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12560.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20708.79},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17856.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21550.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12683.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12930.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12314.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":21333.19,"10th_percentile":21333.19,"90th_percentile":21333.19,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":29111.78,"10th_percentile":29111.78,"90th_percentile":29111.78,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":57093.48,"10th_percentile":57093.48,"90th_percentile":97643.07},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19384.35,"10th_percentile":19384.35,"90th_percentile":19384.35,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":74009.49,"10th_percentile":74009.49,"90th_percentile":74009.49},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":69028.8,"10th_percentile":69028.8,"90th_percentile":69028.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26494.29,"maximum":46365.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27024.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":43506.02},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38416.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46365.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27289.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27819.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":26494.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17138.93,"maximum":29993.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17481.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":26655.51},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24851.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29993.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17653.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17995.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":17138.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11985.25,"maximum":20974.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12224.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20801.61},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17378.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20974.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12344.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12584.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11985.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26129.88,"maximum":45727.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26652.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":45455.23},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37888.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45727.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26913.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27436.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":26129.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":63541.17,"10th_percentile":63541.17,"90th_percentile":63541.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35337.29,"10th_percentile":35337.29,"90th_percentile":35337.29,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15430.3,"maximum":27003.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15738.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":26496.21},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22373.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27003.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15893.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16201.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15430.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19047.82,"10th_percentile":19047.82,"90th_percentile":19047.82,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11232.28,"maximum":19656.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11456.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19253.78},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16286.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19656.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11569.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11793.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11232.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13203.64,"10th_percentile":13203.64,"90th_percentile":13203.64,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":27482.38,"10th_percentile":27482.38,"90th_percentile":27482.38,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18899.51,"maximum":33796.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19277.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":33796.34},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27404.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33074.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19466.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19844.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":18899.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11010.56,"maximum":19268.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11230.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18679.3},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15965.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19268.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11561.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11010.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8679.96,"maximum":15618.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8853.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15618.77},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12585.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15189.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8940.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9113.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8679.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":13692.34,"10th_percentile":13692.34,"90th_percentile":13692.34,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":10328.22,"10th_percentile":10328.22,"90th_percentile":10328.22,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":43738.42,"10th_percentile":43738.42,"90th_percentile":43738.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16797.93,"maximum":29684.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17133.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":29684.69},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24357.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29396.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17301.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17637.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":16797.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5407.37,"10th_percentile":5407.37,"90th_percentile":5407.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9577.08,"maximum":16759.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9768.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15789.35},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13886.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16759.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9864.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10055.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9577.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6370.57,"maximum":11148.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6497.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11049.29},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9237.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11148.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6561.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6689.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6370.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":7553.8,"10th_percentile":7553.8,"90th_percentile":7553.8,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18234.35,"maximum":31910.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18599.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":30351.99},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26439.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31910.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18781.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19146.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":18234.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11155.45,"maximum":19522.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11378.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18873.72},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16175.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19522.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11490.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11713.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11155.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":167.53,"10th_percentile":167.53,"90th_percentile":167.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5698.51,"10th_percentile":5698.51,"90th_percentile":5698.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8545.32,"maximum":14954.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8716.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13828.86},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12390.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14954.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8801.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8972.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8545.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21235.24,"maximum":37161.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21659.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":36786.64},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30791.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37161.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21872.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22297.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":21235.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":38946.38,"10th_percentile":38946.38,"90th_percentile":38946.38,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34108.43,"10th_percentile":34108.43,"90th_percentile":34108.43,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28249.25,"10th_percentile":28249.25,"90th_percentile":28249.25,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12310.88,"maximum":21544.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12557.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":21337.2},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17850.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21544.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12680.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12926.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12310.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":28267.99,"10th_percentile":28267.99,"90th_percentile":28267.99,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9841.97,"maximum":17223.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10038.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":16721.31},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14270.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17223.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10137.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10334.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9841.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":38484.64,"10th_percentile":38484.64,"90th_percentile":38484.64},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":12405.39,"10th_percentile":12405.39,"90th_percentile":12405.39,"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":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32144.09,"maximum":56252.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32786.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":53501.68},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46608.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56252.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33108.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33751.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":32144.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49469.43,"10th_percentile":49469.43,"90th_percentile":49469.43,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":92888.78,"10th_percentile":92888.78,"90th_percentile":92888.78,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":34997.85,"10th_percentile":34997.85,"90th_percentile":34997.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17016.73,"maximum":29779.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17357.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":28245.99},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24674.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29779.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17527.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17867.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":17016.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21223.08,"10th_percentile":21223.08,"90th_percentile":21223.08,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22761.74,"10th_percentile":22761.74,"90th_percentile":22761.74,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17100.29,"10th_percentile":17100.29,"90th_percentile":17100.29,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10229.06,"maximum":17900.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10433.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":16996.01},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14832.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17900.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10535.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10740.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10229.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":23550.76,"10th_percentile":23550.76,"90th_percentile":23550.76,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11648.65,"maximum":20945.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11881.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20945.86},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16890.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20385.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11998.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12231.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11648.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17520.18,"10th_percentile":17520.18,"90th_percentile":17520.18,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16875.78,"10th_percentile":16875.78,"90th_percentile":16875.78,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7318.91,"maximum":12808.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7465.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12763.94},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10612.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12808.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7538.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7684.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7318.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9276.6,"10th_percentile":9276.6,"90th_percentile":9276.6,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":11797.76,"10th_percentile":11797.76,"90th_percentile":11797.76,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":9349.09,"10th_percentile":9349.09,"90th_percentile":9349.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":172.63,"10th_percentile":172.63,"90th_percentile":172.63,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5128.07,"maximum":8974.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8753.89},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7435.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8974.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5281.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5384.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5128.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12974.57,"maximum":22705.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13234.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":21929.24},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18813.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22705.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13363.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13623.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12974.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":26511.01,"10th_percentile":26511.01,"90th_percentile":26511.01,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":31407.71,"10th_percentile":31407.71,"90th_percentile":31407.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18007.67,"10th_percentile":18007.67,"90th_percentile":18007.67,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31794.45,"10th_percentile":31794.45,"90th_percentile":31794.45,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7471.11,"maximum":13074.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7620.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12910.7},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10833.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13074.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7695.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7844.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7471.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6839.36,"10th_percentile":6839.36,"90th_percentile":6839.36,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5322.71,"maximum":9314.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5429.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9097.57},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7717.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9314.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5482.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5588.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5322.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":13614.77,"10th_percentile":13614.77,"90th_percentile":13614.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":14557.39,"10th_percentile":14557.39,"90th_percentile":14557.39},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":27396.3,"10th_percentile":27396.3,"90th_percentile":27396.3},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7915.27,"10th_percentile":7915.27,"90th_percentile":7915.27,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15649.83,"maximum":27387.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15962.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":26484.92},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22692.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27387.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16119.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16432.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15649.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19377.2,"10th_percentile":19377.2,"90th_percentile":20317.89,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":40827.08,"10th_percentile":40827.08,"90th_percentile":45715.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":686.53,"10th_percentile":686.53,"90th_percentile":686.53},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8851.19,"maximum":15489.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15411.81},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12834.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15489.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9116.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9293.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8851.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10051.11,"10th_percentile":10051.11,"90th_percentile":10051.11,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":25723.37,"10th_percentile":25723.37,"90th_percentile":25723.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":71928.55,"10th_percentile":71928.55,"90th_percentile":71928.55},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":58114.83,"10th_percentile":58114.83,"90th_percentile":58114.83},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":3333.46,"10th_percentile":3333.46,"90th_percentile":3333.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6763.52,"maximum":11836.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6898.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11074.37},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9807.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11836.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6966.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7101.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6763.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":2524.61,"10th_percentile":2524.61,"90th_percentile":2524.61,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13376.3,"maximum":23408.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13643.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22804.76},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19395.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23408.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13777.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14045.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13376.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":17908.24,"10th_percentile":9828.73,"90th_percentile":21582.12,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":25479.41,"10th_percentile":25479.41,"90th_percentile":25479.41,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26422.16,"10th_percentile":26422.16,"90th_percentile":26422.16,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":15757.19,"10th_percentile":15757.19,"90th_percentile":15757.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":89609.47,"10th_percentile":89609.47,"90th_percentile":89609.47},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":17807.85,"10th_percentile":16548.07,"90th_percentile":18989.26,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":41741.87,"10th_percentile":41741.87,"90th_percentile":41741.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7176.22,"maximum":12558.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7319.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12366.32},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10405.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12558.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7391.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7535.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7176.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":7824.6,"10th_percentile":167.53,"90th_percentile":9931.87,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":8359.02,"10th_percentile":8359.02,"90th_percentile":8360.86,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":17871.02,"10th_percentile":17871.02,"90th_percentile":17871.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":22826.82,"10th_percentile":8779.02,"90th_percentile":34330.02},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":19704.08,"10th_percentile":19704.08,"90th_percentile":33088.25,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":172.63,"10th_percentile":172.63,"90th_percentile":172.63,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":9954.26,"10th_percentile":8278.73,"90th_percentile":11247.63,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":49033.64,"10th_percentile":49033.64,"90th_percentile":49033.64},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10489.51,"10th_percentile":10489.51,"90th_percentile":10489.51,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4612.92,"maximum":8072.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4705.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":7984.99},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6688.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8072.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4751.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4843.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4612.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6482.97,"10th_percentile":6482.97,"90th_percentile":8601.49,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":9266.77,"10th_percentile":9266.77,"90th_percentile":9266.77,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6572.17,"10th_percentile":6572.17,"90th_percentile":6572.17,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7253.32,"10th_percentile":7253.32,"90th_percentile":7253.32,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":18112.54,"10th_percentile":18112.54,"90th_percentile":18112.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14358.3,"maximum":25127.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14645.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":24136.84},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20819.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25127.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14789.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15076.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14358.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19474.61,"10th_percentile":19474.61,"90th_percentile":19474.61,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19170.71,"10th_percentile":19170.71,"90th_percentile":22869.08,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7928.46,"maximum":13874.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8087.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13660.78},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11496.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13874.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8166.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8324.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7928.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11614.5,"10th_percentile":11614.5,"90th_percentile":11614.5,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5858.35,"maximum":10252.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5975.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9398.6},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8494.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10252.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6034.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6151.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5858.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5608.03,"10th_percentile":5608.03,"90th_percentile":5608.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10103.2,"maximum":17680.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10305.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15857.09},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14649.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17680.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10406.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10608.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10103.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":23803.43,"10th_percentile":23803.43,"90th_percentile":23803.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":121.98,"10th_percentile":121.98,"90th_percentile":121.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13046.08,"10th_percentile":13046.08,"90th_percentile":13046.08,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4234.58,"10th_percentile":4234.58,"90th_percentile":4234.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":30508.58,"10th_percentile":30508.58,"90th_percentile":30508.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6254.95,"maximum":10946.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6380.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10907.55},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9069.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10946.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6442.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6567.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6254.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7220.23,"10th_percentile":7220.23,"90th_percentile":7220.23,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":8409.29,"10th_percentile":8409.29,"90th_percentile":8409.29,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11578.4,"maximum":20378.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11809.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20378.9},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16788.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20262.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11925.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12157.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11578.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":167.53,"10th_percentile":167.53,"90th_percentile":167.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":27708.35,"10th_percentile":27708.35,"90th_percentile":27708.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16491.08,"10th_percentile":16491.08,"90th_percentile":16491.08,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4362.09,"10th_percentile":4362.09,"90th_percentile":4362.09,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7144.02,"maximum":12502.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7286.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12447.85},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10358.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12502.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7358.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7501.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7144.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9813.53,"10th_percentile":9813.53,"90th_percentile":9813.53,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":17373.32,"10th_percentile":17373.32,"90th_percentile":17373.32,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10641.81,"10th_percentile":10641.81,"90th_percentile":10641.81,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":44074.67,"10th_percentile":44074.67,"90th_percentile":44074.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4985.38,"maximum":8724.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5085.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8407.69},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7228.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8724.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5134.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5234.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4985.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":10199.09,"10th_percentile":10199.09,"90th_percentile":10199.09,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":13254.49,"10th_percentile":13254.49,"90th_percentile":13254.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10806.41,"maximum":18911.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11022.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18438.47},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15669.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18911.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11130.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11346.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10806.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12734.91,"10th_percentile":12584.1,"90th_percentile":12911.71,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":16661.92,"10th_percentile":16661.92,"90th_percentile":16661.92,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":6047.94,"10th_percentile":6047.94,"90th_percentile":6047.94},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13659.32,"10th_percentile":13659.32,"90th_percentile":13659.32,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15558.51,"10th_percentile":15558.51,"90th_percentile":45410.62,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5779.32,"maximum":10113.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5894.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10055.87},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8380.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10113.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5952.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6068.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5779.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6597.57,"10th_percentile":5122.72,"90th_percentile":14935.25,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":14816.81,"10th_percentile":14816.81,"90th_percentile":14816.81,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":15342.85,"10th_percentile":15342.85,"90th_percentile":18756.83,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":3109.87,"10th_percentile":3109.87,"90th_percentile":17828.44},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8585.32,"10th_percentile":6549.52,"90th_percentile":14974.25,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3980.69,"maximum":6966.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4060.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":6862.37},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5772.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6966.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4100.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4179.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":3980.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8054.75,"10th_percentile":8054.75,"90th_percentile":8054.75,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":11533.8,"10th_percentile":11533.8,"90th_percentile":11986.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":152.28,"10th_percentile":152.28,"90th_percentile":152.28},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3453.18,"10th_percentile":3453.18,"90th_percentile":3453.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6377.96,"10th_percentile":6377.96,"90th_percentile":6377.96,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":17419.72,"10th_percentile":17419.72,"90th_percentile":17419.72},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9280.72,"maximum":16241.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9466.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":16116.73},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13457.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16241.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9559.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9744.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9280.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10893.96,"10th_percentile":167.53,"90th_percentile":12914.12,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":15908.98,"10th_percentile":15908.98,"90th_percentile":15908.98,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":26858.69,"10th_percentile":26858.69,"90th_percentile":26858.69,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":24972.41,"10th_percentile":24972.41,"90th_percentile":28028.34},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11767.9,"10th_percentile":11767.9,"90th_percentile":11767.9,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12972.07,"10th_percentile":11721.09,"90th_percentile":15158.01,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5704.68,"maximum":9983.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5818.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9787.44},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8271.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9983.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5875.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5989.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5704.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":6524.53,"10th_percentile":6169.22,"90th_percentile":8329.23,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":10110.05,"10th_percentile":502.48,"90th_percentile":14544.25,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":14043.89,"10th_percentile":10896.17,"90th_percentile":16206.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":121.98,"10th_percentile":121.98,"90th_percentile":121.98,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":16939.88,"10th_percentile":7578.7,"90th_percentile":32024.21},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":12162.84,"10th_percentile":12162.84,"90th_percentile":12162.84,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10145.54,"10th_percentile":10145.54,"90th_percentile":10145.54,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7375.25,"10th_percentile":6228.34,"90th_percentile":9736.46,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":14903.87,"10th_percentile":14372.44,"90th_percentile":29817.9},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8630.85,"10th_percentile":8630.85,"90th_percentile":8630.85,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":10252.97,"10th_percentile":10252.97,"90th_percentile":10252.97,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":36594.81,"10th_percentile":36594.81,"90th_percentile":36594.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11702.8,"maximum":20770.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11936.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20770.25},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16969.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20479.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12053.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11702.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":430.58,"10th_percentile":430.58,"90th_percentile":16579.32,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":23938.31,"10th_percentile":23938.31,"90th_percentile":23938.31,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16479.81,"10th_percentile":16479.81,"90th_percentile":16479.81,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15197.97,"10th_percentile":15197.97,"90th_percentile":16816.19,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6846.94,"maximum":11982.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6983.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11806.9},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9928.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11982.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7052.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7189.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6846.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7296.38,"10th_percentile":7296.38,"90th_percentile":7296.38,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":12478.63,"10th_percentile":12478.63,"90th_percentile":12478.63,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":20227.9,"10th_percentile":17574.92,"90th_percentile":29645.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":13078.33,"10th_percentile":13078.33,"90th_percentile":35160.75},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9383.04,"10th_percentile":9383.04,"90th_percentile":9736.03,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11553.46,"10th_percentile":11553.46,"90th_percentile":11553.46,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4834.23,"10th_percentile":4834.23,"90th_percentile":4834.23,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4749.02,"maximum":8310.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4844.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":7982.48},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6886.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8310.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4891.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4986.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4749.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":9130.97,"10th_percentile":8087.28,"90th_percentile":13274.19,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14401.8,"10th_percentile":14401.8,"90th_percentile":14401.8,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":19929.16,"10th_percentile":19929.16,"90th_percentile":19929.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17524.56,"maximum":31076.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17875.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":31076.98},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25410.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30667.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18050.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18400.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":17524.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":45008.88,"10th_percentile":45008.88,"90th_percentile":45008.88,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11075.69,"maximum":19382.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11297.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18981.59},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16059.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19382.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11407.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11629.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11075.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":17431.79,"10th_percentile":17431.79,"90th_percentile":17431.79,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":74606.24,"10th_percentile":74606.24,"90th_percentile":74606.24},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15401.28,"10th_percentile":15401.28,"90th_percentile":15401.28,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8376.28,"maximum":14658.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8543.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14099.79},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12145.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14658.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8627.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8795.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8376.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":72095.85,"10th_percentile":72095.85,"90th_percentile":72095.85,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":28472.01,"10th_percentile":28472.01,"90th_percentile":28472.01},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29419.8,"maximum":51484.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30008.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":49284.66},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42658.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51484.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30302.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30890.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":29419.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36344.78,"10th_percentile":36344.78,"90th_percentile":36344.78,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40030.1,"maximum":70052.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40830.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":68089.4},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58043.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70052.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41231.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42031.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":40030.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":151587.31,"10th_percentile":151587.31,"90th_percentile":151587.31},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21222.06,"maximum":37138.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21646.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":35223.76},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30771.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37138.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21858.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22283.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":21222.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":60866.49,"10th_percentile":60866.49,"90th_percentile":60866.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16241.81,"maximum":28423.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16566.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":26787.22},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23550.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28423.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16729.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17053.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":16241.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26091.09,"maximum":45659.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26612.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":43914.93},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37832.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45659.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26873.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27395.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":26091.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":53627.55,"10th_percentile":53627.55,"90th_percentile":53627.55,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15932.28,"maximum":27881.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16250.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":26294.27},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23101.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27881.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16410.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16728.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15932.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22098.73,"10th_percentile":22098.73,"90th_percentile":22098.73,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11617.91,"maximum":20331.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11850.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19454.47},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16845.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20331.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11966.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12198.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11617.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24171.73,"maximum":42300.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24655.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":34323.16},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35049.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42300.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24896.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25380.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":24171.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15384.94,"maximum":26923.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15692.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":26735.79},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22308.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26923.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15846.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16154.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15384.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12150.62,"maximum":21263.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12393.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20851.78},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17618.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21263.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12515.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12758.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12150.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26069.14,"maximum":45621.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26590.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":43946.29},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37800.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45621.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26851.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27372.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":26069.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34087.88,"10th_percentile":34087.88,"90th_percentile":34087.88,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15122.97,"maximum":26465.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15425.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":24810.41},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21928.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26465.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15576.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15879.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15122.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":293.3,"10th_percentile":293.3,"90th_percentile":293.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9975.88,"maximum":17457.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10175.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":17186.67},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14465.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17457.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10275.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10474.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9975.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17462.36,"maximum":30559.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17811.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":29808.87},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25320.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30559.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17986.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18335.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":17462.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":56557.54,"10th_percentile":56557.54,"90th_percentile":95086.61},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22589.12,"10th_percentile":22589.12,"90th_percentile":22589.12,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46108.11,"10th_percentile":46108.11,"90th_percentile":46108.11,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12378.2,"maximum":21661.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12625.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20802.86},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17948.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21661.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12749.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12997.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12378.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14424.7,"10th_percentile":14424.7,"90th_percentile":14424.7,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":24466.88,"10th_percentile":24466.88,"90th_percentile":24466.88,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":28715.6,"10th_percentile":28715.6,"90th_percentile":29080.68,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":61729.83,"10th_percentile":42794.23,"90th_percentile":77403.3},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":57838.54,"10th_percentile":57838.54,"90th_percentile":57838.54,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16585.89,"10th_percentile":16585.89,"90th_percentile":16585.89,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15468.38,"10th_percentile":15468.38,"90th_percentile":15468.38,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9994.17,"maximum":17489.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10194.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":16526.89},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14491.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17489.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10294.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10493.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9994.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11928.83,"10th_percentile":11928.83,"90th_percentile":11928.83,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":18155.89,"10th_percentile":18155.89,"90th_percentile":18155.89,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":22676.95,"10th_percentile":17377.6,"90th_percentile":23170.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":37528.04,"10th_percentile":37528.04,"90th_percentile":59305.49},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13706.51,"10th_percentile":13706.51,"90th_percentile":13706.51,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":49557.11,"10th_percentile":49557.11,"90th_percentile":49557.11},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":53424.08,"10th_percentile":53424.08,"90th_percentile":53424.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24931.28,"maximum":44267.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25429.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":44267.39},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36150.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43629.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25679.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26177.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":24931.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":9252.2,"10th_percentile":9252.2,"90th_percentile":9259.15,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5558.48,"10th_percentile":5558.48,"90th_percentile":5558.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5364.53,"10th_percentile":284.75,"90th_percentile":8430.24,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12714.07,"maximum":22249.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12968.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20539.46},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18435.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22249.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13095.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13349.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12714.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4227.65,"10th_percentile":4227.65,"90th_percentile":4227.65,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3294.87,"10th_percentile":3294.87,"90th_percentile":3294.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10240.77,"maximum":18429.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10445.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18429.69},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14849.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17921.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10547.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10752.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10240.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":740.69,"10th_percentile":740.69,"90th_percentile":740.69,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":177.2,"10th_percentile":177.2,"90th_percentile":177.2,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3190.4,"10th_percentile":3190.4,"90th_percentile":3190.4,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30389.36,"maximum":53181.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30997.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":51014.37},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44064.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53181.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31301.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31908.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":30389.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16009.85,"maximum":28637.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16330.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":28637.33},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23214.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28017.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16490.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16810.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":16009.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10978.37,"maximum":19387.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11197.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19387.99},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15918.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19212.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11307.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11527.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10978.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":80647.06,"maximum":141132.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82260.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":131472.6},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":116938.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":141132.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83066.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84679.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":80647.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52821.73,"maximum":92438.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53878.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":89040.27},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76591.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":92438.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54406.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55462.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":52821.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41138.7,"maximum":71992.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41961.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":69052.71},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59651.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71992.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42372.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43195.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":41138.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":65927.28,"maximum":115372.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67245.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":104610.12},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":95594.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":115372.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67905.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69223.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":65927.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42200.46,"maximum":73850.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43044.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":68612.45},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61190.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73850.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43466.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44310.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":42200.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":115351.93,"10th_percentile":115351.93,"90th_percentile":115351.93,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14402.2,"maximum":25203.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14690.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":24573.34},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20883.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25203.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14834.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15122.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14402.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21397.05,"10th_percentile":328.98,"90th_percentile":22401.4,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":41031.72,"10th_percentile":41031.72,"90th_percentile":41031.72,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":29216.93,"10th_percentile":1475.59,"90th_percentile":42210.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":24039.14,"10th_percentile":21454.31,"90th_percentile":89875.63},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18858.79,"10th_percentile":18858.79,"90th_percentile":18858.79,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20307.05,"10th_percentile":20307.05,"90th_percentile":20665.32,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19506.46,"10th_percentile":19506.46,"90th_percentile":19506.46,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7728.69,"maximum":13525.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7883.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13417.44},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11206.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13525.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7960.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8115.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7728.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10233.48,"10th_percentile":10233.48,"90th_percentile":10233.48,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":1251.7,"10th_percentile":1251.7,"90th_percentile":1251.7,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":17982.59,"10th_percentile":17982.59,"90th_percentile":17982.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9967.05,"10th_percentile":9967.05,"90th_percentile":9974.68,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5213.68,"maximum":9123.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5317.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8735.07},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7559.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9123.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5370.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5474.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5213.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13439.96,"maximum":23519.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13708.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22885.03},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19487.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23519.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13843.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14111.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13439.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7105.55,"10th_percentile":7105.55,"90th_percentile":11436.62,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":26394.83,"10th_percentile":26394.83,"90th_percentile":26394.83,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":32795.09,"10th_percentile":32795.09,"90th_percentile":32795.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":72863.47,"10th_percentile":72863.47,"90th_percentile":72863.47},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18700.76,"10th_percentile":16900.78,"90th_percentile":20270.39,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22932.9,"10th_percentile":22932.9,"90th_percentile":22932.9,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8276.77,"maximum":14484.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8442.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14143.69},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12001.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14484.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8525.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8690.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8276.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":15528.89,"10th_percentile":15528.89,"90th_percentile":15528.89,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":8574.56,"10th_percentile":8574.56,"90th_percentile":8574.56},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6243.98,"maximum":10926.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6368.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9847.65},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9053.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10926.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6431.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6556.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6243.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11928.9,"maximum":20875.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12167.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20869.34},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17296.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20875.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12286.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12525.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11928.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17098.62,"10th_percentile":17098.62,"90th_percentile":17098.62,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":35001.93,"10th_percentile":35001.93,"90th_percentile":57287.6,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":25667.94,"10th_percentile":19299.59,"90th_percentile":54780.69},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16419.59,"10th_percentile":15702.08,"90th_percentile":18920.34,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":33020.49,"10th_percentile":33020.49,"90th_percentile":33020.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6155.44,"maximum":10789.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6278.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10789.64},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8925.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10772.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6340.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6463.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6155.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":20655.23,"10th_percentile":20655.23,"90th_percentile":20655.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5693.23,"10th_percentile":5693.23,"90th_percentile":7306.02,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":13654.52,"10th_percentile":1146.15,"90th_percentile":17516.07,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":16041.64,"10th_percentile":14159.38,"90th_percentile":18564.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":19265.73,"10th_percentile":9335.49,"90th_percentile":22607.21},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":245.85,"10th_percentile":245.85,"90th_percentile":21384.95,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8267.55,"10th_percentile":8267.55,"90th_percentile":8279.71,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4547.06,"maximum":7957.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4638.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":7715.31},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6593.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7957.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4683.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4774.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4547.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":4032.59,"10th_percentile":4032.59,"90th_percentile":10713.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":19061.05,"10th_percentile":19061.05,"90th_percentile":19061.05,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7789.46,"10th_percentile":7789.46,"90th_percentile":7789.46,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":21042.4,"10th_percentile":21042.4,"90th_percentile":21042.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13132.62,"maximum":23710.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13395.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":23710.37},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19042.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22982.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13526.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13789.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13132.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16231.78,"10th_percentile":16231.78,"90th_percentile":16231.78,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":24485.23,"10th_percentile":24485.23,"90th_percentile":24485.23,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":33121.34,"10th_percentile":33121.34,"90th_percentile":33121.34,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":75228.53,"10th_percentile":75228.53,"90th_percentile":75228.53},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":25564.25,"10th_percentile":25564.25,"90th_percentile":25564.25,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19794.29,"10th_percentile":19794.29,"90th_percentile":19794.29,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":15688.95,"10th_percentile":15688.95,"90th_percentile":15688.95,"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."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7063.53,"maximum":12361.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7204.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12119.22},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10242.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12361.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7275.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7416.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7063.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9617.47,"10th_percentile":9617.47,"90th_percentile":9617.47,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":8156.4,"10th_percentile":8156.4,"90th_percentile":8156.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":185.0,"10th_percentile":185.0,"90th_percentile":185.0},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8137.81,"10th_percentile":8137.81,"90th_percentile":8137.81,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5120.02,"maximum":8960.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5222.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8812.84},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7424.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8960.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5273.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5376.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5120.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":10356.92,"10th_percentile":10356.92,"90th_percentile":10356.92},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":767.6,"10th_percentile":767.6,"90th_percentile":767.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12226.72,"maximum":21396.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":21128.99},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17728.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21396.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12593.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12838.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12226.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14656.56,"10th_percentile":14656.56,"90th_percentile":14656.56,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":10032.2,"10th_percentile":10032.2,"90th_percentile":10032.2},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15584.56,"10th_percentile":15584.56,"90th_percentile":15584.56,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17954.63,"10th_percentile":17954.63,"90th_percentile":17954.63,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8008.22,"maximum":14014.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8168.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13601.82},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11611.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14014.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8248.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8408.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8008.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10846.87,"10th_percentile":10846.87,"90th_percentile":10846.87,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":18358.34,"10th_percentile":18358.34,"90th_percentile":18358.34,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":49827.85,"10th_percentile":49827.85,"90th_percentile":49827.85},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9286.85,"10th_percentile":9239.58,"90th_percentile":9956.5,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":33813.97,"10th_percentile":33813.97,"90th_percentile":33813.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6053.73,"maximum":10594.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6174.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9999.42},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8777.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10594.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6235.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6356.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6053.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":13936.36,"10th_percentile":13936.36,"90th_percentile":13936.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48892.26,"maximum":85561.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49870.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":84091.99},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70893.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":85561.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50359.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51336.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":48892.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31031.84,"maximum":54305.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31652.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":51216.31},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44996.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54305.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31962.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32583.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":31031.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39798.05,"10th_percentile":39798.05,"90th_percentile":39798.05,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":73633.34,"10th_percentile":73633.34,"90th_percentile":73633.34,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38999.07,"maximum":68248.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39779.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":64593.61},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":56548.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":68248.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40169.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40949.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":38999.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23638.29,"maximum":41367.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24111.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":38705.74},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34275.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41367.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24347.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24820.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":23638.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":137911.0,"10th_percentile":137911.0,"90th_percentile":137911.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39179.39,"10th_percentile":39179.39,"90th_percentile":39179.39,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":61491.45,"maximum":107610.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62721.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":106223.17},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":89162.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":107610.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63336.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64566.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":61491.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43634.68,"maximum":76360.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44507.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":71985.31},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63270.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76360.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44943.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45816.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":43634.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30532.79,"maximum":54157.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31143.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":54157.69},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44272.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53432.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31448.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32059.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":30532.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40414.27,"maximum":76973.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41222.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":76973.73},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58600.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70724.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41626.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42434.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":40414.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19464.41,"maximum":35918.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19853.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":35918.65},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28223.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34062.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20048.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20437.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":19464.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41705.8,"maximum":72985.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42539.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":67741.95},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60473.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":72985.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42956.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43791.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":41705.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4756.44,"10th_percentile":4756.44,"90th_percentile":4794.61,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":54063.14,"10th_percentile":54063.14,"90th_percentile":54063.14,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6082.39,"10th_percentile":4390.59,"90th_percentile":6137.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":288.08,"10th_percentile":288.08,"90th_percentile":288.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22791.66,"maximum":39885.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23247.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":36984.82},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33047.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39885.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23475.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23931.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":22791.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":55442.4,"10th_percentile":55442.4,"90th_percentile":55442.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":336.0,"10th_percentile":336.0,"90th_percentile":336.0},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13344.83,"maximum":23353.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13611.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":21773.71},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19350.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23353.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13745.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14012.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13344.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16897.93,"10th_percentile":16897.93,"90th_percentile":16897.93,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38090.25,"maximum":66657.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38852.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":63898.72},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55230.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66657.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39232.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39994.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":38090.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":19069.62,"10th_percentile":19069.62,"90th_percentile":19069.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25805.71,"maximum":45159.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26321.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":42959.14},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37418.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45159.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26579.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27096.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":25805.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":103555.65,"10th_percentile":103555.65,"90th_percentile":103555.65},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20108.35,"maximum":35189.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20510.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":32903.27},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29157.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35189.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20711.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21113.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":20108.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24204.38,"10th_percentile":24204.38,"90th_percentile":24204.38,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22195.28,"maximum":40997.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22639.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":40997.38},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32183.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38841.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22861.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23305.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":22195.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31512.66,"10th_percentile":31512.66,"90th_percentile":31512.66,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14114.63,"maximum":24700.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14396.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":23650.17},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20466.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24700.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14538.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14820.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14114.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16846.26,"10th_percentile":16846.26,"90th_percentile":16846.26,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19134.59,"10th_percentile":19134.59,"90th_percentile":19134.59,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21274.02,"10th_percentile":21274.02,"90th_percentile":21274.02,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35333.76,"maximum":61834.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36040.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":60922.23},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51233.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61834.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36393.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37100.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":35333.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":103846.88,"10th_percentile":103846.88,"90th_percentile":103846.88},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21557.93,"maximum":37726.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21989.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":36337.59},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31259.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37726.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22204.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22635.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":21557.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33416.26,"10th_percentile":33416.26,"90th_percentile":33416.26,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":66120.88,"10th_percentile":66120.88,"90th_percentile":66120.88,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":51802.07,"10th_percentile":51802.07,"90th_percentile":51802.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17864.09,"maximum":31262.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18221.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":29692.22},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25902.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31262.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18400.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18757.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":17864.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":83267.55,"10th_percentile":83267.55,"90th_percentile":83267.55},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31413.07,"maximum":56248.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32041.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":56248.64},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45548.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":54972.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32355.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32983.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":31413.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":202.05,"10th_percentile":202.05,"90th_percentile":43493.49,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46129.0,"10th_percentile":46129.0,"90th_percentile":46494.74,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16652.32,"maximum":29141.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16985.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":27056.89},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24145.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29141.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17151.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17484.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":16652.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19392.09,"10th_percentile":19392.09,"90th_percentile":19392.09,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":34530.28,"10th_percentile":34530.28,"90th_percentile":34530.28,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25610.05,"10th_percentile":25610.05,"90th_percentile":25610.05,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20566.61,"10th_percentile":20566.61,"90th_percentile":20566.61,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8636.05,"maximum":15113.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8808.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14587.72},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12522.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15113.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8895.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9067.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8636.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25278.86,"maximum":44238.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25784.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":43133.49},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36654.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44238.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26037.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26542.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":25278.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17995.07,"maximum":31491.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18354.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":29330.97},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26092.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31491.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18534.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18894.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":17995.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13602.4,"maximum":23804.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13874.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22272.92},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19723.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23804.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14010.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14282.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13602.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16176.85,"10th_percentile":16176.85,"90th_percentile":16176.85,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21310.61,"maximum":37293.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21736.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":36889.49},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30900.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37293.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21949.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22376.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":21310.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27170.91,"10th_percentile":27126.7,"90th_percentile":28999.18,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28193.67,"10th_percentile":28193.67,"90th_percentile":28193.67,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15326.4,"maximum":26821.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15632.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":26025.84},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22223.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26821.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15786.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16092.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15326.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18889.6,"10th_percentile":18135.5,"90th_percentile":20691.14,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":30324.05,"10th_percentile":30324.05,"90th_percentile":30324.05,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21941.92,"10th_percentile":21941.92,"90th_percentile":21941.92,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":66757.66,"10th_percentile":66757.66,"90th_percentile":66757.66},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":207.96,"10th_percentile":207.96,"90th_percentile":207.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11934.76,"maximum":20885.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12173.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19898.5},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17305.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20885.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12292.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12531.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11934.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14417.06,"10th_percentile":14417.06,"90th_percentile":14417.06,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15625.58,"10th_percentile":15625.58,"90th_percentile":15795.55,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20283.24,"maximum":35495.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20688.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":31961.28},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29410.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35495.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20891.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21297.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":20283.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":38490.22,"10th_percentile":38490.22,"90th_percentile":38490.22,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25891.19,"10th_percentile":25891.19,"90th_percentile":25891.19,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25345.94,"10th_percentile":25345.94,"90th_percentile":25345.94,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23614.14,"maximum":41324.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24086.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":40434.2},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34240.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41324.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24322.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24794.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":23614.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":82265.39,"10th_percentile":82265.39,"90th_percentile":82265.39},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15301.52,"maximum":26777.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15607.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":26600.32},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22187.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26777.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15760.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16066.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15301.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11460.59,"maximum":20056.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11689.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19819.48},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16617.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20056.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11804.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12033.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11460.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12943.83,"maximum":24651.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13202.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":24651.11},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18768.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22651.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13332.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13591.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12943.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8172.13,"maximum":15535.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8335.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15535.98},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11849.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14301.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8417.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8580.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8172.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26866.74,"maximum":47016.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27404.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":44540.83},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38956.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47016.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27672.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28210.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":26866.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18557.78,"maximum":32476.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18928.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":30116.18},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26908.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32476.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19114.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19485.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":18557.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28387.74,"10th_percentile":28387.74,"90th_percentile":28387.74,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":42785.79,"10th_percentile":42785.79,"90th_percentile":42785.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":118214.59,"10th_percentile":89017.69,"90th_percentile":345702.0},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":87587.51,"10th_percentile":87587.51,"90th_percentile":87587.51,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23084.56,"10th_percentile":23084.56,"90th_percentile":23084.56,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":44634.21,"10th_percentile":44634.21,"90th_percentile":44634.21},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24152.75,"10th_percentile":24152.75,"90th_percentile":24152.75,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":125478.27,"10th_percentile":125478.27,"90th_percentile":125478.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14682.46,"maximum":25694.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14976.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":23650.17},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21289.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25694.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15122.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15416.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14682.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":33017.57,"10th_percentile":33017.57,"90th_percentile":33017.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":71619.26,"10th_percentile":71619.26,"90th_percentile":71619.26},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23874.18,"10th_percentile":23874.18,"90th_percentile":23874.18,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19540.01,"10th_percentile":19540.01,"90th_percentile":19540.01,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26530.87,"maximum":46429.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27061.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":44155.76},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38469.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46429.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27326.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27857.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":26530.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13199.95,"maximum":24746.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13463.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":24746.44},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19139.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23099.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13595.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13859.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13199.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19313.28,"10th_percentile":19313.28,"90th_percentile":19313.28,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18442.38,"10th_percentile":18442.38,"90th_percentile":18442.38,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8841.67,"maximum":16845.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9018.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":16845.49},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12820.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15472.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9106.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9283.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8841.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22075.28,"maximum":38631.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22516.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":31667.77},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32009.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38631.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22737.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23179.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":22075.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14560.12,"maximum":25800.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15038.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14560.12},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21377.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25800.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15185.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15480.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14743.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22858.13,"10th_percentile":22858.13,"90th_percentile":22858.13,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23158.26,"maximum":40526.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23621.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":39743.07},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33579.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40526.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23853.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24316.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":23158.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31185.02,"10th_percentile":31185.02,"90th_percentile":31185.02,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":969430.03,"10th_percentile":969430.03,"90th_percentile":969430.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30428.33,"10th_percentile":30428.33,"90th_percentile":30428.33,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12791.63,"maximum":22388.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13047.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22388.32},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18547.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22385.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13175.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13431.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12791.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":167.53,"10th_percentile":167.53,"90th_percentile":167.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":45065.76,"10th_percentile":45065.76,"90th_percentile":45065.76,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9848.55,"maximum":17524.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10045.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":17524.08},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14280.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17234.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10144.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10340.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9848.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20423.73,"maximum":35741.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20832.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":33195.53},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29614.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35741.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21036.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21444.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":20423.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13677.77,"maximum":23936.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13951.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22020.81},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19832.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23936.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14088.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14361.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13677.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":39917.55,"10th_percentile":39917.55,"90th_percentile":39917.55,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13118.72,"maximum":22957.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13381.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22020.81},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19022.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22957.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13512.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13774.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13118.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9872.7,"maximum":18802.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10070.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18802.23},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14315.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17277.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10168.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10366.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9872.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13218.24,"maximum":24309.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13482.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":24309.94},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19166.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23131.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13614.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13879.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13218.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11081.54,"maximum":19392.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11303.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":16188.23},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16068.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19392.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11413.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11635.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11081.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22032.1,"maximum":22032.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22032.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22102.35,"maximum":38679.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22544.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":35848.41},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32048.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38679.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22765.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23207.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":22102.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15215.9,"maximum":26627.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15520.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":24602.19},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22063.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26627.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15672.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15976.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15215.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19446.49,"10th_percentile":19446.49,"90th_percentile":19446.49,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":32808.23,"10th_percentile":32808.23,"90th_percentile":32808.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12113.3,"maximum":21198.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12355.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20165.67},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17564.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21198.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12476.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12718.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12113.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11519.86,"maximum":20159.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11750.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18883.76},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16703.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20159.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11865.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12095.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11519.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":35184.91,"10th_percentile":35184.91,"90th_percentile":35184.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":53465.08,"10th_percentile":53465.08,"90th_percentile":53465.08,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":8929.06,"10th_percentile":8929.06,"90th_percentile":8929.06,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7480.63,"maximum":13091.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7630.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12789.03},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10846.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13091.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7705.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7854.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7480.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23319.98,"maximum":40809.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23786.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":38786.02},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33813.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40809.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24019.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24485.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":23319.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29236.73,"10th_percentile":29236.73,"90th_percentile":29236.73,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30053.2,"10th_percentile":30053.2,"90th_percentile":30053.2,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15206.39,"maximum":26611.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15510.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":25231.86},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22049.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26611.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15662.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15966.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15206.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17778.41,"10th_percentile":17778.41,"90th_percentile":17778.41,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":42983.28,"10th_percentile":42983.28,"90th_percentile":42983.28,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":122489.12,"10th_percentile":122489.12,"90th_percentile":122489.12},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22033.12,"10th_percentile":22033.12,"90th_percentile":22033.12,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11244.72,"maximum":19678.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11469.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18721.95},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16304.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19678.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11806.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11244.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27347.5,"maximum":47858.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27894.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":44952.25},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39653.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47858.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28167.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28714.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":27347.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14636.36,"maximum":25613.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14929.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":24731.39},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21222.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25613.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15075.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15368.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14636.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":39897.16,"10th_percentile":39897.16,"90th_percentile":39897.16},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":7222.43,"10th_percentile":7222.43,"90th_percentile":11006.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10931.54,"maximum":19130.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11150.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":17975.63},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15850.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19130.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11259.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11478.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10931.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":55426.54,"10th_percentile":55426.54,"90th_percentile":55426.54},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21002.54,"maximum":36754.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21422.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":36558.35},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30453.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36754.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21632.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22052.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":21002.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28195.84,"10th_percentile":28195.84,"90th_percentile":28195.84,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28907.13,"10th_percentile":28907.13,"90th_percentile":28907.13,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15496.16,"maximum":27118.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15806.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":26443.53},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22469.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27118.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15961.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16270.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15496.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23483.03,"10th_percentile":23483.03,"90th_percentile":23483.03,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":40009.5,"10th_percentile":40009.5,"90th_percentile":40009.5,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19510.31,"10th_percentile":19510.31,"90th_percentile":19510.31,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20117.56,"10th_percentile":20117.56,"90th_percentile":21968.72,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":214811.17,"10th_percentile":214811.17,"90th_percentile":214811.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11471.56,"maximum":20075.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11700.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19125.84},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16633.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20075.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11815.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12045.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11471.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5898.6,"maximum":10322.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6016.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10208.89},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8552.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10322.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6075.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6193.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5898.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9380.97,"maximum":16681.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9568.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":16681.18},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13602.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16416.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9662.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9850.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9380.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5909.57,"maximum":10341.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6027.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10171.26},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8568.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10341.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6086.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6205.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5909.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":167.53,"10th_percentile":167.53,"90th_percentile":167.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":13631.18,"10th_percentile":13631.18,"90th_percentile":13631.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":172.63,"10th_percentile":172.63,"90th_percentile":172.63,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6519.73,"10th_percentile":6519.73,"90th_percentile":6519.73,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6983.04,"maximum":12220.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7122.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11525.93},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10125.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12220.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7192.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7332.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6983.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5270.76,"maximum":9223.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5376.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8422.75},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7642.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9223.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5428.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5534.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5270.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14413.18,"maximum":25371.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14701.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":25371.09},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20899.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25223.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14845.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15133.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14413.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18056.06,"10th_percentile":18056.06,"90th_percentile":18056.06,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":7732.12,"10th_percentile":6953.16,"90th_percentile":10114.98,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5663.97,"10th_percentile":5663.97,"90th_percentile":6469.46,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"25","median_amount":5559.09,"10th_percentile":5554.79,"90th_percentile":9147.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9485.61,"maximum":16599.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9675.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":16235.89},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13754.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16599.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9770.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9959.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9485.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":12939.39,"10th_percentile":12939.39,"90th_percentile":12939.39,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"34","median_amount":7985.56,"10th_percentile":6334.23,"90th_percentile":10241.33,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":26172.0,"10th_percentile":26172.0,"90th_percentile":32283.52},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"35","median_amount":7430.04,"10th_percentile":5893.59,"90th_percentile":9528.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"68","median_amount":7292.47,"10th_percentile":5784.46,"90th_percentile":9359.7,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":35281.14,"10th_percentile":35281.14,"90th_percentile":35281.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5761.76,"maximum":10972.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5877.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10972.77},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8354.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10083.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5934.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6049.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5761.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":7113.44,"10th_percentile":7113.44,"90th_percentile":7113.44,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6623.71,"10th_percentile":6623.71,"90th_percentile":6623.71,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6496.03,"10th_percentile":6496.03,"90th_percentile":100710.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12926.27,"maximum":23391.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13184.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":23391.78},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18743.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22620.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13314.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13572.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12926.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":7048.98,"10th_percentile":7043.53,"90th_percentile":7048.98,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":22312.62,"10th_percentile":22312.62,"90th_percentile":22312.62},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6553.54,"10th_percentile":6553.54,"90th_percentile":6553.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18517.73,"10th_percentile":18517.73,"90th_percentile":18517.73,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17922.02,"10th_percentile":17922.02,"90th_percentile":17922.02,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6432.19,"10th_percentile":6432.19,"90th_percentile":6437.18,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7522.34,"maximum":13305.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7672.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13305.81},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10907.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13164.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7748.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7898.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7522.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":171.74,"10th_percentile":171.74,"90th_percentile":171.74,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":41189.29,"10th_percentile":41189.29,"90th_percentile":41189.29},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5852.64,"10th_percentile":5852.64,"90th_percentile":5852.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11214.95,"10th_percentile":11214.95,"90th_percentile":11214.95,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9006.7,"10th_percentile":9006.7,"90th_percentile":9006.7,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5521.75,"maximum":9663.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5632.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9478.88},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8006.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9663.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5687.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5797.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5521.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18159.71,"maximum":31779.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18522.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":31692.85},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26331.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31779.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18704.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19067.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":18159.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":125432.61,"10th_percentile":125432.61,"90th_percentile":125432.61,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":18576.8,"10th_percentile":18576.8,"90th_percentile":18576.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":11839.25,"10th_percentile":11839.25,"90th_percentile":11839.25,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30257.3,"10th_percentile":30257.3,"90th_percentile":30257.3,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8439.95,"maximum":14769.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8608.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14521.24},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12237.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14769.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8693.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8861.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8439.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":97031.12,"10th_percentile":97031.12,"90th_percentile":97031.12},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":357.0,"10th_percentile":357.0,"90th_percentile":357.0},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6118.85,"maximum":10707.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6241.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9359.72},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8872.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10707.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6302.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6424.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6118.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":18760.6,"10th_percentile":18760.6,"90th_percentile":18760.6,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5895.96,"10th_percentile":5895.96,"90th_percentile":5895.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14129.26,"maximum":25268.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14411.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":25268.24},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20487.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24726.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14553.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14835.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14129.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":8891.43,"10th_percentile":8891.43,"90th_percentile":8891.43,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8833.62,"maximum":15458.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9010.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15114.53},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12808.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15458.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9098.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9275.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8833.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6396.18,"maximum":11193.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6524.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10813.48},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9274.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11193.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6588.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6715.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6396.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6895.72,"10th_percentile":6895.72,"90th_percentile":6895.72,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12264.78,"maximum":21463.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12510.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":21402.43},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17783.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21463.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12632.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12878.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12264.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15586.07,"10th_percentile":15586.07,"90th_percentile":15586.07,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":28044.85,"10th_percentile":28044.85,"90th_percentile":28044.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15795.92,"10th_percentile":15795.92,"90th_percentile":15795.92,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17035.76,"10th_percentile":17035.76,"90th_percentile":17035.76,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7034.26,"maximum":12309.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7174.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12089.12},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10199.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12309.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7245.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7385.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7034.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":28669.61,"10th_percentile":28669.61,"90th_percentile":28669.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9553.08,"10th_percentile":8448.85,"90th_percentile":9686.73,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":16140.82,"10th_percentile":16140.82,"90th_percentile":16140.82,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13169.0,"10th_percentile":13169.0,"90th_percentile":13169.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":16993.82,"10th_percentile":16993.82,"90th_percentile":20367.69,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":25953.4,"10th_percentile":20618.15,"90th_percentile":60177.24},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9670.37,"10th_percentile":9350.93,"90th_percentile":9908.08,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9485.61,"maximum":16599.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9675.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":16385.16},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13754.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16599.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9770.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9959.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9485.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13083.82,"10th_percentile":13083.82,"90th_percentile":13083.82,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6074.21,"maximum":10629.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6195.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10468.54},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8807.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10629.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6256.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6377.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6074.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7171.06,"10th_percentile":7171.06,"90th_percentile":7171.06,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":832.15,"10th_percentile":832.15,"90th_percentile":832.15,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6698.38,"10th_percentile":6698.38,"90th_percentile":6698.38,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9672.2,"maximum":16926.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9865.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":16889.39},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14024.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16926.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9962.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10155.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9672.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13669.94,"10th_percentile":13669.94,"90th_percentile":13669.94,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6077.87,"maximum":10636.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6199.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10241.51},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8812.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10636.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6260.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6381.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6077.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":26061.32,"10th_percentile":26061.32,"90th_percentile":26061.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9097.08,"10th_percentile":9097.08,"90th_percentile":9097.08,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":41918.51,"10th_percentile":41918.51,"90th_percentile":41918.51,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":169063.1,"10th_percentile":169063.1,"90th_percentile":169063.1},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10880.31,"maximum":19438.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11097.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19438.17},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15776.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19040.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11206.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11424.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10880.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":9151.33,"10th_percentile":9151.33,"90th_percentile":9151.33,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":58446.76,"10th_percentile":58446.76,"90th_percentile":58446.76},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6535.94,"maximum":11437.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6666.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10834.8},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9477.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11437.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6732.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6862.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6535.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6936.18,"10th_percentile":6936.18,"90th_percentile":7012.01,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":10132.7,"10th_percentile":10132.7,"90th_percentile":10132.7,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":10661.25,"10th_percentile":10661.25,"90th_percentile":10661.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":17710.92,"10th_percentile":17710.92,"90th_percentile":17710.92},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":172.63,"10th_percentile":172.63,"90th_percentile":172.63,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7337.39,"10th_percentile":7337.39,"90th_percentile":8841.05,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":16636.15,"10th_percentile":16636.15,"90th_percentile":16636.15},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11144.74,"10th_percentile":11144.74,"90th_percentile":11144.74,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13646.31,"maximum":23881.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13919.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":23281.4},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19787.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23881.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14055.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14328.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13646.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":91564.12,"10th_percentile":91564.12,"90th_percentile":91564.12},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8240.18,"maximum":14420.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8404.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14284.17},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11948.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14420.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8487.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8652.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8240.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17653.22,"10th_percentile":17653.22,"90th_percentile":24829.97,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":9430.98,"10th_percentile":9430.98,"90th_percentile":23131.41,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":5949.0,"10th_percentile":5288.0,"90th_percentile":9915.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"61","median_amount":6162.88,"10th_percentile":5506.44,"90th_percentile":6167.64,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":22929.03,"10th_percentile":14100.73,"90th_percentile":43139.43},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"63","median_amount":5734.15,"10th_percentile":5123.38,"90th_percentile":7162.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17276.58,"10th_percentile":17276.58,"90th_percentile":17276.58,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":30328.85,"10th_percentile":30328.85,"90th_percentile":30328.85},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9606.57,"10th_percentile":9606.57,"90th_percentile":9606.57,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":64767.3,"10th_percentile":64767.3,"90th_percentile":64767.3},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49807.33,"10th_percentile":49807.33,"90th_percentile":49807.33,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"149","median_amount":5627.98,"10th_percentile":5028.51,"90th_percentile":5632.33,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":30016.8,"10th_percentile":30016.8,"90th_percentile":63334.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5882.5,"maximum":10294.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6000.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10255.3},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8529.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10294.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6058.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6176.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5882.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":2974.5,"10th_percentile":2974.5,"90th_percentile":2974.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3243.79,"10th_percentile":3241.28,"90th_percentile":13834.66,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":40700.56,"10th_percentile":40700.56,"90th_percentile":64053.23},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":12517.73,"10th_percentile":12517.73,"90th_percentile":12517.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5246.5,"10th_percentile":2962.25,"90th_percentile":7298.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":42355.2,"10th_percentile":42355.2,"90th_percentile":42355.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10425.9,"maximum":18359.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10634.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18359.45},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15117.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18245.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10738.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10947.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10425.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13708.29,"10th_percentile":13708.29,"90th_percentile":13708.29,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13937.94,"10th_percentile":13937.94,"90th_percentile":13937.94,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6552.78,"maximum":11467.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6683.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11209.84},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9501.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11467.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6749.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6880.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6552.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8769.81,"10th_percentile":8769.81,"90th_percentile":8769.81,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":393.98,"10th_percentile":393.98,"90th_percentile":393.98,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":10146.43,"10th_percentile":10146.43,"90th_percentile":10146.43},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9044.34,"10th_percentile":9044.34,"90th_percentile":9932.79,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11295.21,"maximum":19766.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11521.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19682.76},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16378.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19766.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11634.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11859.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11295.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":167.53,"10th_percentile":167.53,"90th_percentile":167.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7130.12,"maximum":12789.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7272.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12789.03},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10338.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12477.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7344.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7486.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7130.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8125.33,"10th_percentile":8125.33,"90th_percentile":8125.33,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":18309.29,"10th_percentile":18309.29,"90th_percentile":18309.29,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10753.45,"10th_percentile":10753.45,"90th_percentile":10753.45,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5482.96,"maximum":9595.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5592.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9382.3},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7950.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9595.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5647.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5757.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5482.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4865.34,"10th_percentile":4297.62,"90th_percentile":13008.73,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4530.38,"10th_percentile":3750.84,"90th_percentile":12208.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"22","median_amount":3681.39,"10th_percentile":1667.84,"90th_percentile":6179.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":4540.8,"10th_percentile":4540.8,"90th_percentile":4540.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21521.35,"maximum":37759.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21951.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":37759.99},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31205.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37662.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22166.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22597.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":21521.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29030.89,"10th_percentile":29030.89,"90th_percentile":29030.89,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":54757.05,"10th_percentile":54757.05,"90th_percentile":54757.05,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12362.83,"maximum":21634.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12610.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":21007.32},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17926.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21634.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12733.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12980.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12362.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":22868.26,"10th_percentile":22868.26,"90th_percentile":22868.26,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":121656.24,"10th_percentile":121656.24,"90th_percentile":121656.24},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8387.99,"maximum":14678.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8555.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14329.33},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12162.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14678.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8639.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8807.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8387.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47939.53,"maximum":83894.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48898.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":77238.39},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":69512.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":83894.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49377.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50336.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":47939.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25401.79,"maximum":44453.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25909.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":43458.36},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36832.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44453.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26163.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26671.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":25401.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13149.45,"maximum":25042.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13412.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":25042.46},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19066.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23011.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13543.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13806.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13149.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35864.28,"maximum":67669.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36581.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":67669.2},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52003.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62762.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36940.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37657.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":35864.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":75203.88,"10th_percentile":75203.88,"90th_percentile":75203.88,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19396.36,"maximum":33943.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19784.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":33397.47},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28124.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33943.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19978.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20366.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":19396.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11754.75,"maximum":21201.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11989.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":21201.74},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17044.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20570.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12107.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12342.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11754.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23697.56,"maximum":41470.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24171.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":40879.48},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34361.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41470.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24408.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24882.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":23697.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":57322.45,"10th_percentile":57322.45,"90th_percentile":57322.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12644.55,"maximum":22237.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12897.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22237.8},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18334.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22127.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13023.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13276.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12644.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":53793.82,"10th_percentile":53793.82,"90th_percentile":53793.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23435.47,"10th_percentile":23435.47,"90th_percentile":23435.47,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":14745.87,"10th_percentile":14745.87,"90th_percentile":14745.87,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":29530.56,"10th_percentile":29530.56,"90th_percentile":29530.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":72103.36,"10th_percentile":72103.36,"90th_percentile":72103.36},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":172.63,"10th_percentile":172.63,"90th_percentile":172.63,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17766.77,"10th_percentile":17766.77,"90th_percentile":17766.77,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":75561.6,"10th_percentile":75561.6,"90th_percentile":75561.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10559.81,"maximum":18479.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10771.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18050.89},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15311.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18479.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10876.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11087.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10559.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1440.82,"10th_percentile":1440.82,"90th_percentile":1440.82,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":65107.8,"10th_percentile":65107.8,"90th_percentile":65107.8},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1312.25,"10th_percentile":1312.25,"90th_percentile":1312.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14097.8,"maximum":24671.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14379.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":21964.36},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20441.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24671.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14520.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14802.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14097.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy Without Cc/Mcc","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12618.21,"maximum":22081.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12870.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20602.17},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18296.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22081.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12996.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13249.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12618.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":86280.31,"10th_percentile":86280.31,"90th_percentile":86280.31,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15664.46,"maximum":27412.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15977.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":25679.65},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22713.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27412.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16134.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16447.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15664.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":28948.51,"10th_percentile":28948.51,"90th_percentile":28948.51,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":123.75,"10th_percentile":123.75,"90th_percentile":123.75,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22247.06,"10th_percentile":22247.06,"90th_percentile":22247.06,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14116.09,"maximum":24898.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14398.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":24898.21},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20468.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24703.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14539.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14821.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14116.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":23139.31,"10th_percentile":23139.31,"90th_percentile":23139.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":27620.37,"10th_percentile":27620.37,"90th_percentile":27620.37,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4462.01,"10th_percentile":4462.01,"90th_percentile":4462.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14161.46,"maximum":25791.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14444.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":25791.29},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20534.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24782.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14586.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14869.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14161.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17168.51,"10th_percentile":17168.51,"90th_percentile":17168.51,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20242.03,"10th_percentile":20242.03,"90th_percentile":20242.03,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18581.76,"10th_percentile":18581.76,"90th_percentile":18581.76,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8680.69,"maximum":15335.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8854.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15335.29},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12587.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15191.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8941.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9114.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8680.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":102467.89,"10th_percentile":74440.04,"90th_percentile":118743.44,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":95339.69,"10th_percentile":95339.69,"90th_percentile":95339.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11606.86,"10th_percentile":11606.86,"90th_percentile":12111.08,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":174564.0,"10th_percentile":174564.0,"90th_percentile":174564.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6342.76,"maximum":11099.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6469.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10644.14},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9197.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11099.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6533.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6659.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6342.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15518.11,"maximum":27156.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15828.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":26528.83},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22501.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27156.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15983.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16294.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15518.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20878.73,"10th_percentile":20878.73,"90th_percentile":20878.73,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7921.14,"maximum":13862.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8079.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13559.18},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11485.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13862.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8158.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8317.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7921.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12198.92,"maximum":22032.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12442.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22032.1},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17688.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21348.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12564.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12808.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12198.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":68586.33,"10th_percentile":68586.33,"90th_percentile":68586.33},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8278.23,"maximum":14486.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8443.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13532.84},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12003.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14486.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8526.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8692.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8278.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5630.04,"maximum":10723.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5742.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10723.16},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8163.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9852.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5798.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5911.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5630.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7621.85,"maximum":13338.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7774.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12006.33},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11051.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13338.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7850.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8002.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7621.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4427.06,"maximum":7747.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4515.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":7519.64},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6419.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7747.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4559.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4648.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4427.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10400.29,"maximum":18430.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10608.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18430.95},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15080.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18200.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10712.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10920.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10400.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8643.21,"10th_percentile":8643.21,"90th_percentile":14352.91,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":32796.37,"10th_percentile":32796.37,"90th_percentile":32796.37,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19506.49,"10th_percentile":19506.49,"90th_percentile":19506.49,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":26731.62,"10th_percentile":26731.62,"90th_percentile":26731.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":75577.68,"10th_percentile":75577.68,"90th_percentile":75577.68,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":51376.94,"10th_percentile":51376.94,"90th_percentile":51376.94},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":78135.65,"10th_percentile":78135.65,"90th_percentile":78135.65,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13060.0,"10th_percentile":13060.0,"90th_percentile":13060.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":25199.06,"10th_percentile":25199.06,"90th_percentile":25199.06},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":96234.0,"10th_percentile":82806.0,"90th_percentile":229762.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":249.18,"10th_percentile":249.18,"90th_percentile":249.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6372.77,"maximum":11152.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6500.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11049.29},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9240.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11152.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6563.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6372.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8348.26,"10th_percentile":8348.26,"90th_percentile":9075.96,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":10184.51,"10th_percentile":10184.51,"90th_percentile":12021.59,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":14718.14,"10th_percentile":7282.73,"90th_percentile":18790.98,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":19156.4,"10th_percentile":19156.4,"90th_percentile":64551.92},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":15072.81,"10th_percentile":15072.81,"90th_percentile":15072.81,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10342.06,"10th_percentile":10342.06,"90th_percentile":10342.06,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8589.81,"10th_percentile":7168.81,"90th_percentile":10641.72,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":24134.64,"10th_percentile":24134.64,"90th_percentile":24134.64},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5433.65,"10th_percentile":5433.65,"90th_percentile":5433.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":17856.64,"10th_percentile":17856.64,"90th_percentile":20090.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10772.02,"maximum":18851.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10987.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18635.4},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15619.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18851.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11095.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11310.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10772.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6702.78,"maximum":11729.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6836.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11586.14},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9719.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11729.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6903.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7037.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6702.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":1337.7,"10th_percentile":1337.7,"90th_percentile":1337.7,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11072.76,"maximum":20195.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11294.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20195.77},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16055.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19377.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11404.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11626.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11072.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6632.54,"maximum":11606.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6765.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10841.07},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9617.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11606.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6831.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6632.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9296.2,"10th_percentile":9296.2,"90th_percentile":9296.2,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":855.52,"10th_percentile":855.52,"90th_percentile":855.52,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":47886.09,"10th_percentile":47886.09,"90th_percentile":47886.09,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":85044.0,"10th_percentile":85044.0,"90th_percentile":85044.0},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":50539.7,"10th_percentile":50539.7,"90th_percentile":50539.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":73854.0,"10th_percentile":73854.0,"90th_percentile":163374.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16038.38,"maximum":28583.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16359.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":28583.4},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23255.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28067.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16519.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16840.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":16038.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":22965.2,"10th_percentile":22965.2,"90th_percentile":23064.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":10970.96,"10th_percentile":10970.96,"90th_percentile":10970.96},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":21367.63,"10th_percentile":21367.63,"90th_percentile":21367.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":10776.16,"10th_percentile":10776.16,"90th_percentile":20988.22,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10239.31,"maximum":17973.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10444.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":17973.12},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14847.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17918.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10546.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10751.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10239.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14631.45,"10th_percentile":14631.45,"90th_percentile":14631.45,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25518.87,"maximum":48478.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26029.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":48478.14},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37002.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44658.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26284.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26794.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":25518.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36305.14,"10th_percentile":36305.14,"90th_percentile":41056.12,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":208.19,"10th_percentile":208.19,"90th_percentile":208.19,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37805.22,"10th_percentile":37805.22,"90th_percentile":37805.22,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13685.82,"maximum":24235.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13959.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":24235.93},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19844.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23950.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14096.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14370.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13685.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17520.36,"10th_percentile":17520.36,"90th_percentile":17520.36,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":33304.62,"10th_percentile":33304.62,"90th_percentile":33304.62,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20050.63,"10th_percentile":20050.63,"90th_percentile":20050.63,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10378.34,"maximum":18162.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10585.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15616.26},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15048.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18162.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10689.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10897.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10378.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21128.4,"maximum":36974.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21550.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":34197.73},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30636.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36974.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21762.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22184.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":21128.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11710.11,"maximum":20492.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11944.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20030.2},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16979.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20492.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12061.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12295.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11710.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11037.64,"maximum":19315.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11258.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18334.37},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16004.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19315.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11368.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11589.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11037.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":39036.59,"10th_percentile":39036.59,"90th_percentile":39036.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":14326.66,"10th_percentile":14326.66,"90th_percentile":14326.66,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26044.26,"maximum":46961.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26565.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":46961.67},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37764.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45577.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26825.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27346.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":26044.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":17797.22,"10th_percentile":17797.22,"90th_percentile":21073.37,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":35471.25,"10th_percentile":35471.25,"90th_percentile":35471.25},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":16559.16,"10th_percentile":16559.16,"90th_percentile":16559.16,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38883.52,"10th_percentile":38883.52,"90th_percentile":38883.52,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":16252.54,"10th_percentile":10446.28,"90th_percentile":62664.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13126.77,"maximum":24007.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13389.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":24007.65},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19033.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22971.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13520.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13783.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13126.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17334.19,"10th_percentile":17334.19,"90th_percentile":17334.19,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":33380.82,"10th_percentile":33380.82,"90th_percentile":33380.82,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":34324.78,"10th_percentile":34324.78,"90th_percentile":34324.78,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":28189.3,"10th_percentile":28189.3,"90th_percentile":28189.3},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20323.03,"10th_percentile":20323.03,"90th_percentile":20323.03,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":9869.62,"10th_percentile":9869.62,"90th_percentile":9869.62,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9160.71,"maximum":16031.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9343.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12582.06},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13283.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16031.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9435.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9618.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9160.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22099.43,"maximum":38674.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22541.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":35960.04},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32044.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38674.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22762.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23204.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":22099.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":12948.15,"10th_percentile":12948.15,"90th_percentile":12948.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":12698.56,"10th_percentile":12698.56,"90th_percentile":12708.4,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10971.78,"maximum":19200.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11191.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18930.17},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15909.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19200.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11300.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11520.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10971.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"14","median_amount":2673.01,"10th_percentile":2671.01,"90th_percentile":2727.62,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2482.14,"10th_percentile":2482.14,"90th_percentile":6056.09,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13879.27,"10th_percentile":13879.27,"90th_percentile":13879.27,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"25","median_amount":2487.36,"10th_percentile":2367.0,"90th_percentile":5945.27,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9719.77,"maximum":17009.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9914.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15889.7},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14093.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17009.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10011.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9719.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":21788.35,"10th_percentile":21788.35,"90th_percentile":21788.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":75753.46,"10th_percentile":75753.46,"90th_percentile":75753.46},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":52423.72,"10th_percentile":52423.72,"90th_percentile":52423.72},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27270.67,"maximum":49499.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27816.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":49499.15},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39542.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47723.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28088.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28634.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":27270.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39076.21,"10th_percentile":39076.21,"90th_percentile":39076.21,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40984.01,"10th_percentile":40984.01,"90th_percentile":40984.01,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18376.22,"10th_percentile":18376.22,"90th_percentile":18376.22,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15943.26,"maximum":28223.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16262.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":28223.41},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23117.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27900.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16421.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16740.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15943.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26683.23,"10th_percentile":26683.23,"90th_percentile":26683.23,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10679.82,"maximum":18689.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10893.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":17575.5},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15485.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18689.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11000.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11213.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10679.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10512.98,"maximum":18397.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10723.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18266.63},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15243.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18397.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10828.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11038.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10512.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12848.46,"10th_percentile":167.53,"90th_percentile":17148.06,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":19950.75,"10th_percentile":8797.85,"90th_percentile":82115.95,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":17910.94,"10th_percentile":293.3,"90th_percentile":25667.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":26753.05,"10th_percentile":26753.05,"90th_percentile":53720.1},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":19715.79,"10th_percentile":19715.79,"90th_percentile":19715.79,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":14754.3,"10th_percentile":12804.01,"90th_percentile":17765.17,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":19599.18,"10th_percentile":19599.18,"90th_percentile":19599.18},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14996.06,"10th_percentile":14996.06,"90th_percentile":14996.06,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":18939.91,"10th_percentile":18939.91,"90th_percentile":18939.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6557.9,"maximum":11504.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6689.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11504.6},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9508.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11476.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6754.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6885.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6557.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":8989.23,"10th_percentile":8989.23,"90th_percentile":29110.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8546.55,"10th_percentile":8285.92,"90th_percentile":8945.63,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":12425.9,"10th_percentile":11163.72,"90th_percentile":15935.09,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"11","median_amount":16840.57,"10th_percentile":14897.53,"90th_percentile":19542.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"12","median_amount":14060.7,"10th_percentile":10746.42,"90th_percentile":15571.53},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9561.02,"10th_percentile":8532.74,"90th_percentile":10794.98,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10942.77,"10th_percentile":10942.77,"90th_percentile":10942.77,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":6596.44,"10th_percentile":6596.44,"90th_percentile":6940.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4545.6,"maximum":7954.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4636.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":7859.56},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6591.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7954.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4681.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4772.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4545.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":7609.22,"10th_percentile":7609.22,"90th_percentile":7609.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5022.0,"10th_percentile":5022.0,"90th_percentile":5022.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":11817.53,"10th_percentile":11817.53,"90th_percentile":11817.53,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":10558.14,"10th_percentile":10558.14,"90th_percentile":13015.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5086.67,"10th_percentile":5086.67,"90th_percentile":8216.13,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":19650.97,"10th_percentile":19650.97,"90th_percentile":23647.85},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4799.63,"10th_percentile":4799.63,"90th_percentile":4799.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7368.35,"10th_percentile":7368.35,"90th_percentile":7368.35,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":7499.5,"10th_percentile":4641.58,"90th_percentile":21486.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":19078.37,"10th_percentile":19078.37,"90th_percentile":19078.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9773.18,"maximum":17103.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9968.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":16658.6},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14171.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17103.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10066.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10261.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9773.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"21","median_amount":11543.29,"10th_percentile":202.05,"90th_percentile":13620.53,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":25027.0,"10th_percentile":25027.0,"90th_percentile":25574.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"107","median_amount":2156.95,"10th_percentile":2075.89,"90th_percentile":2609.88,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":20043.52,"10th_percentile":15133.11,"90th_percentile":153420.38},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"83","median_amount":2001.96,"10th_percentile":1931.47,"90th_percentile":2421.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14009.05,"10th_percentile":810.57,"90th_percentile":16158.26,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":12736.95,"10th_percentile":11933.04,"90th_percentile":24929.22,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":22014.0,"10th_percentile":22014.0,"90th_percentile":22014.0},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"213","median_amount":1966.21,"10th_percentile":1895.71,"90th_percentile":2378.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5694.44,"maximum":9965.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5808.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9802.5},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8256.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9965.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5865.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5979.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5694.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6460.76,"10th_percentile":363.5,"90th_percentile":9104.93,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":10122.66,"10th_percentile":10122.66,"90th_percentile":12467.48,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":15081.19,"10th_percentile":6232.56,"90th_percentile":17822.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":12139.35,"10th_percentile":12139.35,"90th_percentile":19961.55},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8054.83,"10th_percentile":8054.83,"90th_percentile":8054.83,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7795.14,"10th_percentile":6475.43,"90th_percentile":8564.84,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10406.14,"maximum":18210.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10614.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15567.34},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15088.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18210.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10718.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10926.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10406.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13016.25,"10th_percentile":13016.25,"90th_percentile":13016.25,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12045.25,"maximum":21079.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12286.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20787.81},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17465.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21079.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12406.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12647.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12045.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":29817.55,"10th_percentile":29817.55,"90th_percentile":29817.55,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15000.47,"10th_percentile":15000.47,"90th_percentile":15000.47,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7500.38,"maximum":13125.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7650.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12963.38},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10875.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13125.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7725.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7875.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7500.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":22109.96,"10th_percentile":22109.96,"90th_percentile":22109.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":34489.48,"10th_percentile":34489.48,"90th_percentile":34489.48},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":58012.16,"10th_percentile":58012.16,"90th_percentile":58012.16},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5622.0,"maximum":9838.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5734.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9771.14},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8151.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9838.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5790.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5903.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5622.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34402.25,"maximum":60203.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35090.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":57786.43},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49883.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60203.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35434.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36122.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":34402.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":35629.32,"10th_percentile":35629.32,"90th_percentile":35629.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis Without Mcc","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27117.0,"maximum":47454.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27659.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":43552.43},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39319.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47454.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27930.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28472.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":27117.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant","code_information":[{"code":"652","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23631.7,"maximum":41355.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24104.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":38522.61},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34265.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41355.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24340.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24813.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":23631.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38024.39,"maximum":69918.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38784.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":69918.19},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":55135.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66542.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39165.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39925.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":38024.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20483.73,"maximum":35846.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20893.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":35395.6},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29701.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35846.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21098.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21507.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":20483.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures Without Cc/Mcc","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15488.11,"maximum":27104.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15797.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":26054.69},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22457.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27104.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15952.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16262.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15488.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Mcc","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23297.29,"maximum":40861.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23763.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":40861.92},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33781.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40770.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23996.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24462.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":23297.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":102712.21,"10th_percentile":102712.21,"90th_percentile":102712.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13390.93,"maximum":23434.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13658.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22928.93},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19416.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23434.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13792.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14060.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13390.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18334.52,"10th_percentile":18334.52,"90th_percentile":18334.52,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18125.4,"10th_percentile":18125.4,"90th_percentile":18125.4,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11355.22,"maximum":19871.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11582.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18863.69},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16465.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19871.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11695.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11922.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11355.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18592.9,"maximum":32537.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18964.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":32414.09},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26959.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32537.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19150.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19522.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":18592.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27274.66,"10th_percentile":27274.66,"90th_percentile":27274.66,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9671.47,"maximum":16925.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9864.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":16806.61},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14023.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16925.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9961.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10155.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9671.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":43830.96,"10th_percentile":43830.96,"90th_percentile":43830.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11299.73,"10th_percentile":11299.73,"90th_percentile":11299.73,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":23249.33,"10th_percentile":23249.33,"90th_percentile":23249.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":36181.49,"10th_percentile":36181.49,"90th_percentile":36181.49,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11640.79,"10th_percentile":11640.79,"90th_percentile":11640.79,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7576.49,"maximum":13258.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7728.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12876.83},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10985.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13258.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7803.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7955.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7576.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9589.66,"10th_percentile":9589.66,"90th_percentile":9589.66,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":18123.3,"10th_percentile":18123.3,"90th_percentile":18123.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":29162.89,"10th_percentile":29162.89,"90th_percentile":29162.89},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":20557.64,"10th_percentile":20557.64,"90th_percentile":20557.64,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9663.75,"10th_percentile":9663.75,"90th_percentile":9663.75,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":20206.38,"10th_percentile":20206.38,"90th_percentile":20206.38},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22402.37,"maximum":39204.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22850.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":39127.2},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32483.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39204.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23074.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23522.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":22402.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":1668.69,"10th_percentile":1668.69,"90th_percentile":1668.69,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":8773.28,"10th_percentile":8773.28,"90th_percentile":8773.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6956.89,"10th_percentile":6956.89,"90th_percentile":6956.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11123.99,"maximum":19466.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11346.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19157.2},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16129.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19466.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11457.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11680.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11123.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15969.19,"10th_percentile":15969.19,"90th_percentile":15969.19,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5789.88,"10th_percentile":5789.88,"90th_percentile":5789.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures Without Cc/Mcc","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7660.64,"maximum":13544.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7813.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13544.13},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11107.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13406.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7890.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8043.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7660.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9440.44,"10th_percentile":9440.44,"90th_percentile":9440.44,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Mcc","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22839.22,"maximum":43065.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23296.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":43065.75},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33116.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39968.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23524.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23981.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":22839.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Cc","code_information":[{"code":"666","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12800.41,"maximum":22400.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13056.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20661.13},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18560.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22400.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13184.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13440.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12800.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15124.62,"10th_percentile":15124.62,"90th_percentile":15124.62,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14663.56,"10th_percentile":14663.56,"90th_percentile":14663.56,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy Without Cc/Mcc","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8094.56,"maximum":14165.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8256.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12890.63},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11737.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14165.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8337.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8499.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8094.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21366.95,"maximum":37392.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21794.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":36577.17},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30982.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37392.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22007.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22435.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":21366.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28128.82,"10th_percentile":28128.82,"90th_percentile":28128.82,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11356.68,"maximum":19874.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11583.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19410.57},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16467.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19874.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11697.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11924.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11356.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7151.34,"maximum":12514.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7294.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11986.26},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10369.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12514.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7365.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7508.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7151.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13134.82,"maximum":22985.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13397.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":21619.43},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19045.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22985.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13528.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13791.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13134.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7899.19,"maximum":13823.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8057.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13726.0},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11453.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13823.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8136.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8294.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7899.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30744.99,"maximum":53803.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31359.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":52555.92},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44580.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53803.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31667.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32282.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":30744.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40544.06,"10th_percentile":40544.06,"90th_percentile":40544.06,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":89268.8,"10th_percentile":89268.8,"90th_percentile":89268.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":173456.79,"10th_percentile":173456.79,"90th_percentile":173456.79,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":51351.06,"10th_percentile":51351.06,"90th_percentile":51351.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17112.58,"maximum":29947.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17454.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":28953.42},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24813.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29947.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17625.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17968.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":17112.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25773.25,"10th_percentile":25773.25,"90th_percentile":25773.25,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":31671.16,"10th_percentile":31671.16,"90th_percentile":31671.16,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":35486.76,"10th_percentile":35486.76,"90th_percentile":35486.76},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12010.86,"maximum":21019.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12251.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19632.59},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17415.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21019.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12371.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12611.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12010.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10837.14,"maximum":18965.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11053.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18839.86},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15713.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18965.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11162.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11379.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10837.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":7879.97,"10th_percentile":390.76,"90th_percentile":13444.69,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":204988.36,"10th_percentile":204988.36,"90th_percentile":204988.36,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21978.61,"10th_percentile":21978.61,"90th_percentile":21978.61,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":27678.06,"10th_percentile":27678.06,"90th_percentile":27678.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":197863.63,"10th_percentile":197863.63,"90th_percentile":197863.63},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":273.31,"10th_percentile":273.31,"90th_percentile":24001.09,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16499.84,"10th_percentile":16499.84,"90th_percentile":18049.84,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":13762.38,"10th_percentile":13460.87,"90th_percentile":16512.59,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15250.21,"10th_percentile":15250.21,"90th_percentile":15250.21,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":28239.05,"10th_percentile":28239.05,"90th_percentile":28239.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6408.62,"maximum":11215.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6536.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11149.63},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9292.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11215.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6600.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6729.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6408.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":668.03,"10th_percentile":668.03,"90th_percentile":668.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"28","median_amount":7322.87,"10th_percentile":167.53,"90th_percentile":10202.68,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":9707.53,"10th_percentile":9707.53,"90th_percentile":9707.53,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":14372.16,"10th_percentile":10197.75,"90th_percentile":16407.51,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":14787.36,"10th_percentile":12432.71,"90th_percentile":44164.54},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":8297.69,"10th_percentile":7227.22,"90th_percentile":9621.41,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":525.0,"10th_percentile":525.0,"90th_percentile":525.0},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4392.66,"maximum":7687.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4480.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":7619.98},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6369.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7687.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4524.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4612.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4392.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4984.96,"10th_percentile":4984.96,"90th_percentile":6472.45,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":6799.65,"10th_percentile":6799.65,"90th_percentile":6799.65},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6677.54,"10th_percentile":6677.54,"90th_percentile":6677.54,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13198.48,"maximum":23651.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13462.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":23651.42},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19137.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23097.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13594.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13858.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13198.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7667.22,"maximum":13417.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7820.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13202.95},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11117.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13417.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7897.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8050.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7667.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9816.86,"10th_percentile":9816.86,"90th_percentile":9816.86,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5782.98,"maximum":10120.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5898.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9083.77},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8385.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10120.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5956.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6072.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5782.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8490.44,"maximum":14858.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8660.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14680.54},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12311.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14858.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8914.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8490.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8285.21,"10th_percentile":167.53,"90th_percentile":12642.98,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":167.53,"10th_percentile":167.53,"90th_percentile":167.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":21253.19,"10th_percentile":21253.19,"90th_percentile":29323.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10384.72,"10th_percentile":10384.72,"90th_percentile":10384.72,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":10729.68,"10th_percentile":9763.22,"90th_percentile":11573.18,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":23938.71,"10th_percentile":23938.71,"90th_percentile":23938.71},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12312.86,"10th_percentile":12312.86,"90th_percentile":12312.86,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5923.47,"maximum":10366.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6041.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10067.16},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8589.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10366.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6101.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6219.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5923.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8202.57,"10th_percentile":7327.69,"90th_percentile":9894.42,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":778.73,"10th_percentile":778.73,"90th_percentile":778.73,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":15145.04,"10th_percentile":14877.03,"90th_percentile":15773.68,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":17128.96,"10th_percentile":9373.45,"90th_percentile":45690.3},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6890.57,"10th_percentile":6890.57,"90th_percentile":6890.57,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":8405.25,"10th_percentile":7550.68,"90th_percentile":10202.63,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8884.08,"10th_percentile":8884.08,"90th_percentile":8884.08,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9838.31,"maximum":18442.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10035.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18442.24},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14265.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17217.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10133.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10330.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9838.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":179.92,"10th_percentile":179.92,"90th_percentile":179.92},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14893.55,"10th_percentile":14893.55,"90th_percentile":14893.55,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":11887.47,"10th_percentile":11887.47,"90th_percentile":11887.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5720.05,"maximum":10010.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5834.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9801.24},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8294.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10010.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5891.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6006.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5720.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":11821.83,"10th_percentile":11821.83,"90th_percentile":11821.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":14771.33,"10th_percentile":14771.33,"90th_percentile":14771.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":8359.05,"10th_percentile":8359.05,"90th_percentile":8359.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8369.7,"maximum":14646.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8537.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14144.94},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12136.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14646.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8620.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8788.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8369.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":20772.0,"10th_percentile":20772.0,"90th_percentile":20772.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5041.72,"maximum":8823.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5142.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8676.12},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7310.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8823.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5192.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5293.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5041.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7607.35,"10th_percentile":7607.35,"90th_percentile":7607.35,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7581.3,"10th_percentile":7581.3,"90th_percentile":7581.3,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7886.75,"maximum":13801.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8044.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12565.76},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11435.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13801.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8123.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8281.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7886.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12105.99,"maximum":21185.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12348.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":21083.83},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17553.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21185.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12469.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12711.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12105.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16603.17,"10th_percentile":202.05,"90th_percentile":19670.05,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":293.3,"10th_percentile":293.3,"90th_percentile":293.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":15836.67,"10th_percentile":15836.67,"90th_percentile":15836.67},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17404.17,"10th_percentile":16458.54,"90th_percentile":20389.09,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17479.04,"10th_percentile":17479.04,"90th_percentile":17479.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":29211.96,"10th_percentile":29211.96,"90th_percentile":29211.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7427.21,"maximum":12997.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7575.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12791.53},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10769.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12997.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7650.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7798.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7427.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":167.53,"10th_percentile":167.53,"90th_percentile":6216.95,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":19713.18,"10th_percentile":19713.18,"90th_percentile":19713.18,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":21972.95,"10th_percentile":21972.95,"90th_percentile":21972.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":18007.53,"10th_percentile":18007.53,"90th_percentile":18007.53},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":172.63,"10th_percentile":172.63,"90th_percentile":172.63,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9420.05,"10th_percentile":8571.96,"90th_percentile":10700.48,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18759.29,"10th_percentile":18759.29,"90th_percentile":18759.29,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5048.31,"maximum":8834.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5149.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8706.22},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7320.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8834.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5199.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5300.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5048.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14637.09,"maximum":25614.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14929.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":24340.04},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21223.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25614.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15076.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15368.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14637.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":250.0,"10th_percentile":250.0,"90th_percentile":250.0},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures Without Cc/Mcc","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11226.43,"maximum":19646.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11450.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18594.01},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16278.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19646.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11563.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11787.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11226.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures With Cc/Mcc","code_information":[{"code":"709","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17028.43,"maximum":29799.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17369.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":28184.53},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24691.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29799.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17539.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17879.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":17028.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures Without Cc/Mcc","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10253.21,"maximum":18831.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10458.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18831.08},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14867.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17943.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10560.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10765.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10253.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":58657.0,"10th_percentile":58657.0,"90th_percentile":58657.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":24481.84,"10th_percentile":24481.84,"90th_percentile":24481.84,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15248.1,"maximum":26684.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15553.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":23965.0},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22109.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26684.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15705.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16010.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15248.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8047.0,"maximum":14082.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8207.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13416.19},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11668.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14082.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8288.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8449.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8047.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11001.05,"maximum":19251.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11221.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18136.18},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15951.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19251.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11331.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11551.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11001.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15787.89,"10th_percentile":15787.89,"90th_percentile":15787.89,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14722.2,"10th_percentile":14722.2,"90th_percentile":14722.2,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7737.47,"maximum":13540.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7892.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11785.57},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11219.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13540.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7969.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8124.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7737.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. 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Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. 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Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13833.64,"maximum":24208.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14110.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":23272.62},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20058.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24208.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14248.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14525.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13833.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":12824.9,"10th_percentile":12824.9,"90th_percentile":12824.9,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":17303.22,"10th_percentile":17303.22,"90th_percentile":17303.22},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9828.06,"maximum":17199.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10024.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15450.69},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14250.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17199.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10122.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10319.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9828.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13242.39,"maximum":23174.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13507.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":21684.65},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19201.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23174.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13639.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13904.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13242.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":44641.69,"10th_percentile":44641.69,"90th_percentile":44641.69},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8361.65,"maximum":14632.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8528.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14084.74},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12124.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14632.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8612.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8779.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8361.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10178.68,"10th_percentile":10178.68,"90th_percentile":10178.68,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2777.03,"10th_percentile":2777.03,"90th_percentile":2777.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System Without Cc/Mcc","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4798.05,"maximum":9138.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4894.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9138.96},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6957.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8396.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4941.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5037.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4798.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":604.47,"10th_percentile":604.47,"90th_percentile":604.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":177.2,"10th_percentile":177.2,"90th_percentile":177.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy With Mcc","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8562.88,"maximum":15843.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8734.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15843.29},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12416.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14985.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8819.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8991.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8562.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21505.17,"10th_percentile":21505.17,"90th_percentile":21505.17,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5283.2,"maximum":9335.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5388.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9335.89},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7660.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9245.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5441.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5547.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5283.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10851.04,"maximum":18989.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11068.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18429.69},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15734.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18989.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11176.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11393.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10851.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5935.91,"maximum":10387.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6054.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10249.03},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8607.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10387.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6113.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6232.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5935.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6746.04,"10th_percentile":6746.04,"90th_percentile":6746.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":16599.24,"10th_percentile":16599.24,"90th_percentile":16599.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7746.98,"maximum":13807.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7901.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13807.53},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11233.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13557.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7979.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7746.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4917.33,"maximum":8605.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5015.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":7612.46},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7130.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8605.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5064.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5163.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4917.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15586.17,"maximum":27275.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15897.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":26374.54},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22599.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27275.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16053.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16365.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15586.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9845.63,"maximum":17229.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10042.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15224.91},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14276.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17229.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10141.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10337.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9845.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26156.22,"maximum":49386.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26679.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":49386.26},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37926.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45773.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26940.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27464.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":26156.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15078.33,"maximum":26387.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15379.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":25065.04},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21863.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26387.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15530.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15832.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15078.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10745.67,"maximum":19025.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10960.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19025.5},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15581.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18804.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11068.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11282.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10745.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":27734.96,"10th_percentile":27734.96,"90th_percentile":27734.96},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26216.95,"maximum":49930.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26741.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":49930.64},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38014.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45879.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27003.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27527.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":26216.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13241.65,"maximum":23172.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13506.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22806.01},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19200.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23172.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13638.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13903.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13241.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10435.41,"maximum":18261.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10644.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":17228.06},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15131.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18261.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10748.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10957.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10435.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13426.05,"maximum":23495.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13694.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22911.37},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19467.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23495.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13828.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14097.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13426.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":44166.4,"10th_percentile":44166.4,"90th_percentile":63378.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":24415.53,"10th_percentile":24415.53,"90th_percentile":24415.53,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":33120.62,"10th_percentile":33120.62,"90th_percentile":33120.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":39752.82,"10th_percentile":34661.78,"90th_percentile":45987.5},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":41718.55,"10th_percentile":41718.55,"90th_percentile":41718.55},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":52378.4,"10th_percentile":52378.4,"90th_percentile":52378.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9078.76,"maximum":15887.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9260.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15034.26},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13164.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15887.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9351.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9532.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9078.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":36011.74,"10th_percentile":36011.74,"90th_percentile":36011.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":15993.59,"10th_percentile":15062.24,"90th_percentile":16934.36,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17996.72,"10th_percentile":17996.72,"90th_percentile":17996.72,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"11","median_amount":33898.77,"10th_percentile":26071.78,"90th_percentile":40726.4},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":29884.71,"10th_percentile":29884.71,"90th_percentile":29884.71,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":34185.02,"10th_percentile":27999.66,"90th_percentile":60228.73},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":439.04,"10th_percentile":439.04,"90th_percentile":439.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14994.18,"maximum":26239.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15294.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":24508.12},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21741.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26239.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15444.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15743.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14994.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8323.6,"maximum":14566.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8490.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12854.25},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12069.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14566.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8573.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8739.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8323.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":33543.2,"10th_percentile":33543.2,"90th_percentile":33543.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12711.14,"maximum":22244.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12965.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":21003.55},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18431.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22244.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13092.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13346.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12711.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":18496.12,"10th_percentile":18496.12,"90th_percentile":18496.12},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6290.81,"maximum":11979.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6416.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11979.99},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9121.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11008.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6479.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6605.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6290.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10151.5,"maximum":17765.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10354.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":17086.32},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14719.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17765.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10659.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10151.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18788.28,"maximum":32879.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19164.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":32466.77},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27243.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32879.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19351.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19727.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":18788.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":26492.7,"10th_percentile":26492.7,"90th_percentile":26492.7},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10799.09,"maximum":18898.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11015.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":16174.43},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15658.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18898.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11123.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11339.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10799.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":7707.71,"10th_percentile":7707.71,"90th_percentile":7707.71,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2930.96,"10th_percentile":2930.96,"90th_percentile":2930.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13476.54,"maximum":23583.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13746.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22693.12},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19540.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23583.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13880.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14150.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13476.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":19696.42,"10th_percentile":19696.42,"90th_percentile":19696.42,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":40367.67,"10th_percentile":40367.67,"90th_percentile":40367.67,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7959.92,"maximum":13929.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8119.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13924.18},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11541.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13929.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8198.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8357.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7959.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":167.53,"10th_percentile":167.53,"90th_percentile":167.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":20598.72,"10th_percentile":20598.72,"90th_percentile":20598.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5019.08,"10th_percentile":5019.08,"90th_percentile":5019.08,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5297.09,"10th_percentile":5297.09,"90th_percentile":5297.09,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10864.18,"10th_percentile":10864.18,"90th_percentile":10864.18,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2981.2,"10th_percentile":2981.2,"90th_percentile":2981.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7028.41,"maximum":12299.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7168.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11977.48},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10191.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12299.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7239.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7379.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7028.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4506.6,"10th_percentile":4506.6,"90th_percentile":4506.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10477.85,"maximum":18336.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10687.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":17751.11},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15192.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18336.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10792.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11001.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10477.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":202404.81,"10th_percentile":202404.81,"90th_percentile":202404.81,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7163.78,"maximum":12785.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7307.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12785.26},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10387.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12536.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7378.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7521.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7163.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":18316.45,"10th_percentile":18316.45,"90th_percentile":18316.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4855.86,"maximum":8497.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4952.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8026.38},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7041.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8497.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5001.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5098.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4855.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":11305.18,"10th_percentile":11305.18,"90th_percentile":11305.18,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":4773.84,"10th_percentile":4773.84,"90th_percentile":4773.84,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":36852.82,"10th_percentile":36852.82,"90th_percentile":36852.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7372.33,"maximum":12901.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7519.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12361.3},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10689.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12901.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7593.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7740.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7372.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4053.8,"10th_percentile":4053.8,"90th_percentile":4053.8,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4174.6,"maximum":7951.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4258.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":7951.12},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6053.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7305.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4299.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4383.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4174.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7841.38,"maximum":13751.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7998.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13751.09},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11370.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13722.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8076.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8233.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7841.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":2268.3,"10th_percentile":2268.3,"90th_percentile":2268.3,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":20545.48,"10th_percentile":15679.97,"90th_percentile":29799.71},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":14342.21,"10th_percentile":14342.21,"90th_percentile":14342.21},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12365.02,"maximum":21638.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12612.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":17428.75},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17929.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21638.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12735.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12983.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12365.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":24895.36,"10th_percentile":24895.36,"90th_percentile":24895.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":23134.15,"10th_percentile":23134.15,"90th_percentile":23134.15},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7337.21,"maximum":13495.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7483.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13495.21},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10638.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12840.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7557.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7704.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7337.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":18285.48,"10th_percentile":18285.48,"90th_percentile":18285.48,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":28009.47,"10th_percentile":28009.47,"90th_percentile":28009.47},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4790.73,"maximum":8948.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4886.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8948.3},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6946.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8383.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4934.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5030.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4790.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":17986.8,"10th_percentile":17986.8,"90th_percentile":17986.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":4198.67,"10th_percentile":4198.67,"90th_percentile":4198.67,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5060.0,"10th_percentile":5060.0,"90th_percentile":5060.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":15661.55,"10th_percentile":15661.55,"90th_percentile":15935.12,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":10465.49,"10th_percentile":10465.49,"90th_percentile":10465.49},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5908.34,"10th_percentile":5908.34,"90th_percentile":5908.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6156.17,"maximum":11724.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6279.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11724.11},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8926.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10773.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6340.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6463.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6156.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":18147.82,"10th_percentile":18147.82,"90th_percentile":18147.82,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":7966.46,"10th_percentile":7966.46,"90th_percentile":7966.46},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17965.07,"maximum":31438.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18324.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":23104.54},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26049.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31438.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18504.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18863.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":17965.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":52335.21,"10th_percentile":52335.21,"90th_percentile":52335.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":5411.26,"10th_percentile":5027.0,"90th_percentile":6561.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":32730.29,"10th_percentile":32730.29,"90th_percentile":32730.29},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27651.35,"10th_percentile":27651.35,"90th_percentile":27651.35,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7757.23,"maximum":13584.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7912.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13584.26},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11247.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13575.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7989.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8145.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7757.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5050.0,"10th_percentile":5050.0,"90th_percentile":5050.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":5625.21,"10th_percentile":5027.0,"90th_percentile":38775.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":33935.99,"10th_percentile":33935.99,"90th_percentile":33935.99},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":27025.8,"10th_percentile":27025.8,"90th_percentile":27025.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7008.65,"maximum":12265.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7148.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10974.03},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10162.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12265.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7218.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7359.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7008.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":933.35,"10th_percentile":933.35,"90th_percentile":933.35,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":3518.9,"10th_percentile":3518.9,"90th_percentile":3518.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":24394.5,"10th_percentile":19544.76,"90th_percentile":30607.45},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":25476.0,"10th_percentile":25476.0,"90th_percentile":25476.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":17926.23,"10th_percentile":17130.67,"90th_percentile":22893.15},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":18629.0,"10th_percentile":18629.0,"90th_percentile":18629.0,"additional_payer_notes":"Contracting method is an algorithm described in 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":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12070.13,"maximum":21122.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12311.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20267.27},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17501.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21122.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12432.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12673.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12070.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":18320.6,"10th_percentile":18320.6,"90th_percentile":54658.7,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":5206.46,"10th_percentile":3518.9,"90th_percentile":15090.78,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":27969.76,"10th_percentile":25656.48,"90th_percentile":40651.63},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":23739.45,"10th_percentile":23739.45,"90th_percentile":23739.45,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":28355.12,"10th_percentile":25562.92,"90th_percentile":39604.5},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":18552.98,"10th_percentile":18552.98,"90th_percentile":18552.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8172.13,"maximum":14301.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8335.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13318.35},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11849.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14301.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8417.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8580.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8172.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":23074.89,"10th_percentile":23074.89,"90th_percentile":23074.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":6787.4,"10th_percentile":5267.88,"90th_percentile":9720.5,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"18","median_amount":5028.68,"10th_percentile":3770.25,"90th_percentile":7080.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":34174.23,"10th_percentile":26270.29,"90th_percentile":58400.83},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10327.79,"10th_percentile":10327.79,"90th_percentile":10327.79,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":16630.74,"10th_percentile":13612.93,"90th_percentile":42162.73},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":21504.0,"10th_percentile":21504.0,"90th_percentile":21504.0,"additional_payer_notes":"Contracting method is an algorithm described in 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":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7015.97,"maximum":12277.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7156.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11351.58},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10173.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12277.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7226.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7366.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7015.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":23172.3,"10th_percentile":22230.25,"90th_percentile":23556.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":5985.9,"10th_percentile":5893.59,"90th_percentile":9029.6,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3787.5,"10th_percentile":3787.5,"90th_percentile":5050.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"13","median_amount":5027.0,"10th_percentile":5027.0,"90th_percentile":6561.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"32","median_amount":24864.01,"10th_percentile":19500.47,"90th_percentile":29259.0},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":20453.8,"10th_percentile":19803.42,"90th_percentile":28429.6,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":20782.85,"10th_percentile":19365.3,"90th_percentile":39984.3},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":25380.8,"10th_percentile":16663.92,"90th_percentile":39659.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13187.51,"maximum":23078.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13451.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22611.59},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19121.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23078.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13583.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13846.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13187.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":118265.38,"10th_percentile":118265.38,"90th_percentile":118265.38,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":1241.75,"10th_percentile":1241.75,"90th_percentile":1241.75,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":217143.76,"10th_percentile":60495.71,"90th_percentile":556442.52},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43491.25,"maximum":76109.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44361.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":74569.21},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63062.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76109.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44795.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45665.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":43491.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":31909.0,"10th_percentile":31909.0,"90th_percentile":76010.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":102048.26,"10th_percentile":102048.26,"90th_percentile":102048.26,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":46109.0,"10th_percentile":19656.26,"90th_percentile":61739.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"15","median_amount":28305.46,"10th_percentile":14000.94,"90th_percentile":89265.76,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":64091.01,"10th_percentile":37952.27,"90th_percentile":168449.12},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":11389.36,"10th_percentile":2281.23,"90th_percentile":133317.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":79739.0,"10th_percentile":79739.0,"90th_percentile":79739.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":229018.3,"10th_percentile":229018.3,"90th_percentile":229018.3},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"26","median_amount":25845.21,"10th_percentile":5808.42,"90th_percentile":98472.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":7394.64,"10th_percentile":7394.64,"90th_percentile":7394.64,"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."}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29701.52,"maximum":51977.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30295.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":50926.57},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43067.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51977.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30592.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31186.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":29701.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":35601.0,"10th_percentile":35601.0,"90th_percentile":35601.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":100717.14,"10th_percentile":100717.14,"90th_percentile":100717.14},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":35842.18,"10th_percentile":35842.18,"90th_percentile":35842.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":91758.0,"10th_percentile":91758.0,"90th_percentile":91758.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17921.89,"maximum":31363.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18280.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":30728.28},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25986.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31363.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18459.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18817.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":17921.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":10477.79,"10th_percentile":10477.79,"90th_percentile":10477.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":10253.23,"10th_percentile":10253.23,"90th_percentile":22701.1,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3685.75,"10th_percentile":3685.75,"90th_percentile":3685.75,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":17549.53,"10th_percentile":17549.53,"90th_percentile":26108.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":59380.8,"10th_percentile":59380.8,"90th_percentile":59380.8},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2911.1,"10th_percentile":2911.1,"90th_percentile":2911.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":2591.96,"10th_percentile":2591.96,"90th_percentile":2591.96},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5803.92,"10th_percentile":5803.92,"90th_percentile":5803.92,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30510.83,"maximum":53393.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31121.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":52312.59},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44240.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53393.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31426.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32036.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":30510.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":21767.42,"10th_percentile":21767.42,"90th_percentile":21767.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":2600.34,"10th_percentile":2600.34,"90th_percentile":16355.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":20768.28,"10th_percentile":20768.28,"90th_percentile":20768.28,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":30605.36,"10th_percentile":30605.36,"90th_percentile":30605.36},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2983.83,"10th_percentile":2983.83,"90th_percentile":13026.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":7167.6,"10th_percentile":2927.7,"90th_percentile":38046.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10799.82,"maximum":18899.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11015.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18516.24},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15659.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18899.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11123.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11339.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10799.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":6889.26,"10th_percentile":6889.26,"90th_percentile":6889.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":2442.2,"10th_percentile":2442.2,"90th_percentile":21329.23,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"14","median_amount":1938.0,"10th_percentile":1717.5,"90th_percentile":5985.6,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":8704.15,"10th_percentile":8704.15,"90th_percentile":8704.15,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":24157.18,"10th_percentile":24157.18,"90th_percentile":24157.18},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":13097.46,"10th_percentile":13097.46,"90th_percentile":13097.46,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":67564.58,"10th_percentile":67564.58,"90th_percentile":67564.58,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":5754.94,"10th_percentile":5754.94,"90th_percentile":5754.94},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5980.2,"10th_percentile":5980.2,"90th_percentile":9575.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1462.03,"maximum":2558.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1491.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":2506.13},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2119.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":2558.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1505.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1535.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":1462.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":3083.8,"10th_percentile":2488.96,"90th_percentile":4465.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"13","median_amount":2442.2,"10th_percentile":1343.6,"90th_percentile":2443.6,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":950.0,"10th_percentile":950.0,"90th_percentile":950.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"35","median_amount":912.0,"10th_percentile":405.3,"90th_percentile":1895.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":2333.94,"10th_percentile":2094.43,"90th_percentile":3075.66},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":3660.0,"10th_percentile":1833.17,"90th_percentile":7292.8,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"12","median_amount":1628.14,"10th_percentile":839.31,"90th_percentile":3960.88},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"17","median_amount":2328.0,"10th_percentile":1257.97,"90th_percentile":3760.0,"additional_payer_notes":"Contracting method is an algorithm described in 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":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8539.46,"maximum":16012.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8710.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":16012.62},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12382.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14944.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8795.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8966.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8539.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7320.38,"maximum":12810.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7466.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12144.31},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10614.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12810.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7539.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7686.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7320.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":31346.81,"10th_percentile":31346.81,"90th_percentile":31346.81},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":19197.15,"10th_percentile":19197.15,"90th_percentile":19197.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7003.53,"maximum":12256.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7143.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12144.31},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10155.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12256.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7213.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7353.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7003.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":1731.0,"10th_percentile":1731.0,"90th_percentile":1731.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":22170.82,"10th_percentile":19911.54,"90th_percentile":117725.13},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":24872.37,"10th_percentile":24872.37,"90th_percentile":24872.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33139.99,"maximum":59636.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33802.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":59636.55},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48052.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57994.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34134.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34796.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":33139.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50650.27,"10th_percentile":50650.27,"90th_percentile":50650.27,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20557.64,"maximum":36545.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20968.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":36545.81},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29808.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35975.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21174.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21585.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":20557.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures Without Cc/Mcc","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13968.28,"maximum":24444.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14247.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20592.14},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20254.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24444.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14387.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14666.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13968.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29153.45,"maximum":51018.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29736.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":44962.28},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":42272.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51018.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30028.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30611.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":29153.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13602.4,"maximum":23804.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13874.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22325.61},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19723.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23804.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14010.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14282.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13602.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9922.46,"maximum":17364.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10120.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13866.49},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14387.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17364.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10220.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10418.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9922.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7896.99,"maximum":13819.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8054.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12516.84},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11450.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13819.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8133.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8291.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7896.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":29276.38,"10th_percentile":29276.38,"90th_percentile":29276.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":5050.4,"10th_percentile":5050.4,"90th_percentile":5921.6,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1875.0,"10th_percentile":1875.0,"90th_percentile":1875.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":2582.65,"10th_percentile":2582.65,"90th_percentile":34457.55,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":15899.58,"10th_percentile":15899.58,"90th_percentile":34658.02},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":15633.42,"10th_percentile":15633.42,"90th_percentile":15633.42,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":12276.77,"10th_percentile":12276.77,"90th_percentile":12276.77},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5517.36,"maximum":9655.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5627.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9074.99},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8000.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9655.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5682.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5793.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5517.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":15445.44,"10th_percentile":15445.44,"90th_percentile":15445.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":5359.02,"10th_percentile":3208.42,"90th_percentile":6241.8,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2500.0,"10th_percentile":2500.0,"90th_percentile":2500.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"14","median_amount":3842.0,"10th_percentile":2308.0,"90th_percentile":5738.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":17332.29,"10th_percentile":11553.54,"90th_percentile":20307.59},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"1 through 10","median_amount":30281.28,"10th_percentile":30281.28,"90th_percentile":30281.28},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":11765.67,"10th_percentile":11765.67,"90th_percentile":13856.8,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":10483.2,"10th_percentile":10228.69,"90th_percentile":18969.09},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":9704.23,"10th_percentile":9493.86,"90th_percentile":10930.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4933.42,"maximum":8633.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5032.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":7992.51},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7153.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8633.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5081.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5180.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4933.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":11819.52,"10th_percentile":7354.88,"90th_percentile":12534.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"13","median_amount":5028.51,"10th_percentile":2635.71,"90th_percentile":6854.87,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5738.59,"10th_percentile":5738.59,"90th_percentile":5738.59,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"25","median_amount":2555.65,"10th_percentile":1731.0,"90th_percentile":5123.38,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"71","median_amount":13729.49,"10th_percentile":9848.58,"90th_percentile":18916.96},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"11","median_amount":11572.92,"10th_percentile":4753.46,"90th_percentile":17218.6,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":22602.39,"10th_percentile":22602.39,"90th_percentile":22602.39},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"15","median_amount":12348.91,"10th_percentile":9025.21,"90th_percentile":17422.97},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9361.69,"10th_percentile":9361.69,"90th_percentile":9361.69,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"26","median_amount":11249.15,"10th_percentile":7460.5,"90th_percentile":14957.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16156.19,"maximum":28728.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16479.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":28728.9},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23426.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28273.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16640.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16964.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":16156.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7433.1,"10th_percentile":7433.1,"90th_percentile":7433.1,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9263.16,"maximum":16210.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9448.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15534.73},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13431.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16210.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9541.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9726.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9263.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9782.46,"10th_percentile":9782.46,"90th_percentile":9782.46,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11665.08,"10th_percentile":11665.08,"90th_percentile":11665.08,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7658.44,"maximum":13402.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7811.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11937.34},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11104.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13402.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7888.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8041.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7658.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3807.74,"10th_percentile":3807.74,"90th_percentile":3807.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3563.32,"10th_percentile":3563.32,"90th_percentile":3563.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10275.89,"maximum":17982.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10481.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":17645.75},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14900.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17982.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10584.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10789.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10275.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":11033.35,"10th_percentile":11033.35,"90th_percentile":11033.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8349.38,"10th_percentile":184.08,"90th_percentile":13412.66,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":34470.79,"10th_percentile":34470.79,"90th_percentile":34470.79,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":20335.35,"10th_percentile":20335.35,"90th_percentile":20335.35},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":29674.85,"10th_percentile":29674.85,"90th_percentile":29674.85,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14777.49,"10th_percentile":13162.67,"90th_percentile":17158.33,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29147.53,"10th_percentile":29147.53,"90th_percentile":29147.53,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":24654.18,"10th_percentile":24654.18,"90th_percentile":24654.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6718.88,"maximum":11758.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6853.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11576.1},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9742.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11758.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6920.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6718.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":15359.43,"10th_percentile":9892.97,"90th_percentile":30197.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":7580.92,"10th_percentile":423.98,"90th_percentile":9669.67,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":14858.44,"10th_percentile":13424.83,"90th_percentile":16325.53,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":16251.25,"10th_percentile":16251.25,"90th_percentile":19597.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"12","median_amount":13517.64,"10th_percentile":1702.86,"90th_percentile":27221.85},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":17397.56,"10th_percentile":10446.39,"90th_percentile":18208.25,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":9796.69,"10th_percentile":7738.19,"90th_percentile":11157.47,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2857.2,"10th_percentile":2857.2,"90th_percentile":2857.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":21526.08,"10th_percentile":20012.0,"90th_percentile":30230.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11161.3,"maximum":19532.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11384.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19415.59},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16183.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19532.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11496.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11719.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11161.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":72852.44,"10th_percentile":72852.44,"90th_percentile":72852.44,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":27514.68,"10th_percentile":27514.68,"90th_percentile":27514.68,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":98614.43,"10th_percentile":98614.43,"90th_percentile":98614.43,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16344.28,"10th_percentile":16344.28,"90th_percentile":52073.75,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":2081.44,"10th_percentile":2081.44,"90th_percentile":2081.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15562.02,"maximum":27233.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15873.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":26219.01},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22564.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27233.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16028.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16340.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15562.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":122.33,"10th_percentile":122.33,"90th_percentile":122.33,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":34235.05,"10th_percentile":34235.05,"90th_percentile":34235.05,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":46233.66,"10th_percentile":46233.66,"90th_percentile":46233.66,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7419.89,"maximum":12984.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7568.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12745.13},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10758.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12984.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7642.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7790.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7419.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8368.95,"10th_percentile":8368.95,"90th_percentile":8368.95,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":14569.22,"10th_percentile":14569.22,"90th_percentile":14569.22},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21301.75,"10th_percentile":21301.75,"90th_percentile":21301.75,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4624.63,"maximum":8270.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4717.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8270.97},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6705.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8093.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4763.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4855.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4624.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7393.14,"10th_percentile":7393.14,"90th_percentile":7393.14,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6297.0,"10th_percentile":6297.0,"90th_percentile":6297.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Mcc","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16695.49,"maximum":31798.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17029.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":31798.22},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24208.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29217.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17196.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17530.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":16695.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":6330.0,"10th_percentile":6330.0,"90th_percentile":6330.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5074.75,"10th_percentile":5074.75,"90th_percentile":5188.84,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":22635.31,"10th_percentile":22635.31,"90th_percentile":22635.31},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Cc","code_information":[{"code":"818","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8482.39,"maximum":16155.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8652.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":16155.62},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12299.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14844.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8906.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8482.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":14520.62,"10th_percentile":14520.62,"90th_percentile":14520.62,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":25478.35,"10th_percentile":25478.35,"90th_percentile":25478.35},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6292.27,"maximum":11011.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6418.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10241.51},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9123.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11011.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6481.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6606.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6292.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":41333.46,"10th_percentile":41333.46,"90th_percentile":41333.46},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","code_information":[{"code":"820","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42915.37,"maximum":75101.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43773.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":73025.14},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":62227.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75101.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44202.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45061.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":42915.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Cc","code_information":[{"code":"821","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16380.84,"maximum":28666.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16708.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":27998.89},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23752.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28666.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16872.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17199.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":16380.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":40048.86,"10th_percentile":40048.86,"90th_percentile":40048.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8810.21,"maximum":15417.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8986.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14344.38},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12774.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15417.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9074.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9250.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8810.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33549.04,"maximum":58710.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34220.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":58692.05},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48646.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58710.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34555.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35226.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":33549.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16578.41,"maximum":29012.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16909.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":27586.22},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24038.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29012.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17075.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17407.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":16578.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":74907.54,"10th_percentile":74907.54,"90th_percentile":74907.54},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21103.1,"10th_percentile":21103.1,"90th_percentile":21103.1,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9874.16,"maximum":17279.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15436.89},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14317.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17279.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10170.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10367.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9874.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34229.56,"maximum":59901.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34914.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":59896.19},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49632.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":59901.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35256.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35941.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":34229.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","code_information":[{"code":"827","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16912.09,"maximum":29598.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17250.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":29598.14},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24522.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29596.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17419.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17757.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":16912.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":45472.61,"10th_percentile":45472.61,"90th_percentile":45472.61,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":38663.93,"10th_percentile":38663.93,"90th_percentile":38663.93},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28276.74,"10th_percentile":28276.74,"90th_percentile":28276.74,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12467.47,"maximum":21818.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12716.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20104.21},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18077.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21818.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12841.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13090.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12467.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":50027.66,"10th_percentile":50027.66,"90th_percentile":50027.66},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23123.14,"maximum":40465.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23585.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":38678.15},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33528.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40465.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23816.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24279.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":23123.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11012.76,"maximum":19272.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11233.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18343.15},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15968.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19272.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11343.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11563.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11012.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8799.23,"maximum":15398.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8975.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14435.95},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12758.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15398.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9063.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9239.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8799.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6398.01,"10th_percentile":6398.01,"90th_percentile":6398.01,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":3798.0,"10th_percentile":3798.0,"90th_percentile":3798.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5280.27,"maximum":9373.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5385.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9373.52},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7656.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9240.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5438.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5544.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5280.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":10212.67,"10th_percentile":10212.67,"90th_percentile":10212.67,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":10038.96,"10th_percentile":3798.0,"90th_percentile":11691.38,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":28524.93,"10th_percentile":28524.93,"90th_percentile":28524.93},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":5892.04,"10th_percentile":5892.04,"90th_percentile":5892.04},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3826.29,"maximum":6696.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3902.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":6519.94},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5548.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6696.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3941.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4017.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":3826.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":1422.72,"10th_percentile":1422.72,"90th_percentile":1422.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":6519.94,"10th_percentile":6519.94,"90th_percentile":6519.94,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3750.84,"10th_percentile":3750.84,"90th_percentile":3750.84,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":1303.66,"10th_percentile":1303.66,"90th_percentile":1732.78,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":8767.36,"10th_percentile":3438.26,"90th_percentile":18812.66},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":29847.9,"10th_percentile":29847.9,"90th_percentile":29847.9,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":3716.54,"10th_percentile":3716.54,"90th_percentile":3716.54},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":8906.4,"10th_percentile":8906.4,"90th_percentile":8906.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40172.06,"maximum":70301.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40975.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":69324.9},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58249.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70301.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41377.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42180.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":40172.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15262.73,"maximum":26789.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15567.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":26789.72},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22130.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26709.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15720.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16025.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15262.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22628.9,"10th_percentile":22628.9,"90th_percentile":22628.9,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8923.63,"maximum":15938.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9102.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15938.62},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12939.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15616.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9191.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9369.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8923.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","code_information":[{"code":"837","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35155.22,"maximum":62801.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35858.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":62801.19},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":50975.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61521.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36209.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36912.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":35155.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":104854.43,"10th_percentile":104854.43,"90th_percentile":104854.43,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15274.44,"maximum":26730.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15579.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":25438.82},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22147.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26730.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15732.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16038.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15274.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10565.66,"maximum":18489.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10776.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":17187.92},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15320.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18489.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10882.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11093.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10565.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23671.21,"maximum":41424.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24144.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":40005.22},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34323.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41424.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24381.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24854.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":23671.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30424.51,"10th_percentile":30424.51,"90th_percentile":30424.51,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":249.32,"10th_percentile":249.32,"90th_percentile":249.32,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33585.56,"10th_percentile":33585.56,"90th_percentile":33585.56,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11937.69,"maximum":20890.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12176.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19666.45},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17309.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20890.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12295.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12534.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11937.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":24503.9,"10th_percentile":24503.9,"90th_percentile":24503.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14342.44,"10th_percentile":14342.44,"90th_percentile":14342.44,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":28833.85,"10th_percentile":28833.85,"90th_percentile":28833.85,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":1427.62,"10th_percentile":1427.62,"90th_percentile":1427.62},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":132506.91,"10th_percentile":132506.91,"90th_percentile":132506.91},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7393.55,"maximum":13192.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7541.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13192.92},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10720.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12938.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7615.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7763.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7393.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14596.85,"maximum":25544.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14888.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":23745.49},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21165.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25544.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15034.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15326.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14596.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8908.26,"maximum":15589.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9086.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14990.35},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12916.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15589.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9175.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9353.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8908.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6231.54,"maximum":10905.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6356.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10494.88},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9035.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10905.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6418.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6543.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6231.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","code_information":[{"code":"846","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18970.49,"maximum":33198.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19349.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":32030.26},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27507.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33198.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19539.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19919.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":18970.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":46548.97,"10th_percentile":46548.97,"90th_percentile":46548.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","code_information":[{"code":"847","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9572.69,"maximum":16752.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9764.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15937.36},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13880.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16752.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9859.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10051.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9572.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":97517.07,"10th_percentile":97517.07,"90th_percentile":97517.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":23576.86,"10th_percentile":23441.53,"90th_percentile":23916.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":54374.58,"10th_percentile":45906.47,"90th_percentile":59198.8},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14466.4,"10th_percentile":14417.8,"90th_percentile":16559.1,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6215.44,"maximum":10877.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6339.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":10271.61},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9012.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10877.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6401.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6526.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6215.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Radiotherapy","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19826.63,"maximum":34696.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20223.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":33501.58},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28748.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34696.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20421.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20817.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":19826.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Other Procedures","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":63365.44,"maximum":115538.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64632.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":115538.99},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":91879.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":110889.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65266.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66533.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":63365.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36137.95,"maximum":63241.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36860.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":62734.71},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52400.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":63241.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37222.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37944.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":36137.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":47549.96,"10th_percentile":10999.17,"90th_percentile":79020.8,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":69981.45,"10th_percentile":69981.45,"90th_percentile":71587.26,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":89685.33,"10th_percentile":89685.33,"90th_percentile":90599.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":94891.71,"10th_percentile":94891.71,"90th_percentile":139700.22},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":47385.45,"10th_percentile":47385.45,"90th_percentile":47385.45,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":50078.77,"10th_percentile":49383.27,"90th_percentile":51982.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":338634.6,"10th_percentile":338634.6,"90th_percentile":338634.6},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":31510.69,"10th_percentile":31510.69,"90th_percentile":31510.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14620.99,"maximum":25586.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14913.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":25063.78},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21200.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25586.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15059.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15352.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14620.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17472.89,"10th_percentile":17472.89,"90th_percentile":18430.83,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":42304.22,"10th_percentile":42304.22,"90th_percentile":42340.67,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":44757.0,"10th_percentile":44757.0,"90th_percentile":131822.99},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19798.68,"10th_percentile":19798.68,"90th_percentile":20376.13,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":56176.44,"10th_percentile":56176.44,"90th_percentile":56176.44},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":139581.8,"10th_percentile":139581.8,"90th_percentile":139581.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10955.68,"maximum":20388.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11174.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20388.94},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15885.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19172.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11284.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11503.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10955.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33284.88,"maximum":58248.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33950.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":56586.05},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48263.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58248.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34283.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34949.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":33284.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51093.72,"10th_percentile":51093.72,"90th_percentile":51093.72,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":63286.25,"10th_percentile":63286.25,"90th_percentile":63286.25,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15670.32,"maximum":27423.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15983.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":27330.33},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22721.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27423.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16140.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16453.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15670.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":30459.33,"10th_percentile":30459.33,"90th_percentile":30459.33,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":55479.02,"10th_percentile":55479.02,"90th_percentile":55479.02},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":80273.44,"10th_percentile":80273.44,"90th_percentile":80273.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10192.47,"maximum":17836.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10396.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":16160.63},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14779.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17836.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10498.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10702.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10192.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13344.83,"maximum":23353.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13611.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":23061.89},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19350.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23353.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13745.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14012.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13344.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":251.4,"10th_percentile":251.4,"90th_percentile":251.4,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6426.83,"10th_percentile":6426.83,"90th_percentile":6426.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7302.08,"maximum":12778.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7448.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12541.93},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10588.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12778.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7521.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7667.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7302.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":17979.08,"10th_percentile":17979.08,"90th_percentile":17979.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":22148.0,"10th_percentile":22148.0,"90th_percentile":22148.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8427.37,"10th_percentile":8427.37,"90th_percentile":8427.37,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10441.36,"10th_percentile":10441.36,"90th_percentile":10441.36,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6495.7,"maximum":11367.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6625.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11262.52},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9418.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11367.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6690.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6820.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6495.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":99538.45,"10th_percentile":99538.45,"90th_percentile":99538.45},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9072.09,"10th_percentile":7791.37,"90th_percentile":10286.22,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":10266.34,"10th_percentile":10266.34,"90th_percentile":10266.34},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10963.73,"maximum":19186.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11183.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18512.48},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15897.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19186.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11292.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11511.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10963.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11961.53,"10th_percentile":11961.53,"90th_percentile":11961.53,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":4682.07,"10th_percentile":4682.07,"90th_percentile":4682.07},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6363.25,"maximum":11135.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6490.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11096.95},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9226.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11135.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6554.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6681.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6363.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15316.88,"maximum":26895.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15623.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":26895.09},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22209.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26804.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15776.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16082.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15316.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7545.02,"maximum":13203.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7695.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13170.34},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10940.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13203.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7771.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7922.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7545.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":43084.23,"10th_percentile":43084.23,"90th_percentile":43084.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5339.54,"maximum":9344.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5446.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9024.82},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7742.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9344.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5499.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5606.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5339.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50576.74,"maximum":88509.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51588.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":87256.63},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73336.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":88509.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52094.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53105.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":50576.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":67252.04,"10th_percentile":67252.04,"90th_percentile":79849.37,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":111168.25,"10th_percentile":111168.25,"90th_percentile":111168.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":70582.05,"10th_percentile":70582.05,"90th_percentile":70582.05,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":69597.91,"10th_percentile":69597.91,"90th_percentile":69597.91,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":27082.9,"10th_percentile":27082.9,"90th_percentile":27082.9,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14214.14,"maximum":24874.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14498.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":24613.48},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20610.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24874.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14640.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14924.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14214.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":39281.0,"10th_percentile":32379.2,"90th_percentile":117316.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"51","median_amount":17572.59,"10th_percentile":191.63,"90th_percentile":21659.31,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":25510.81,"10th_percentile":7488.21,"90th_percentile":138759.92,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29321.67,"10th_percentile":29321.67,"90th_percentile":29321.67,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"21","median_amount":33759.23,"10th_percentile":31967.36,"90th_percentile":41306.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"14","median_amount":48534.17,"10th_percentile":24736.72,"90th_percentile":85878.25},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":11962.57,"10th_percentile":11962.57,"90th_percentile":11962.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":23688.14,"10th_percentile":23688.14,"90th_percentile":23688.14,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18662.22,"10th_percentile":18063.14,"90th_percentile":21287.99,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"56","median_amount":19907.15,"10th_percentile":18297.14,"90th_percentile":22736.16,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":22187.2,"10th_percentile":22187.2,"90th_percentile":38741.4},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21014.7,"10th_percentile":19809.5,"90th_percentile":24006.33,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":24506.77,"10th_percentile":11549.93,"90th_percentile":24815.47,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":22880.27,"10th_percentile":20539.77,"90th_percentile":82611.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7487.94,"maximum":13103.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7637.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12932.02},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10857.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13103.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7712.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7862.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7487.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":8324.78,"10th_percentile":6426.34,"90th_percentile":9497.54,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":17140.73,"10th_percentile":15480.16,"90th_percentile":18005.02,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":17960.73,"10th_percentile":6199.47,"90th_percentile":22401.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":12808.03,"10th_percentile":12808.03,"90th_percentile":12808.03,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":24226.97,"10th_percentile":10604.58,"90th_percentile":24749.09},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9174.68,"10th_percentile":9174.68,"90th_percentile":9174.68,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9237.54,"10th_percentile":8697.47,"90th_percentile":10513.89,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":18407.58,"10th_percentile":18407.58,"90th_percentile":18407.58},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10659.01,"10th_percentile":10659.01,"90th_percentile":10659.01,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3591.82,"10th_percentile":3591.82,"90th_percentile":3591.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":21559.16,"10th_percentile":19243.68,"90th_percentile":36619.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28281.21,"maximum":49492.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28846.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":49287.17},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41007.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49492.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29129.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29695.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":28281.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40823.89,"10th_percentile":40823.89,"90th_percentile":40823.89,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7026.21,"maximum":12295.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7166.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12023.89},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10188.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12295.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7237.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7377.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7026.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4403.86,"10th_percentile":4403.86,"90th_percentile":4403.86,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":4504.96,"10th_percentile":619.68,"90th_percentile":24115.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":22780.17,"10th_percentile":7801.31,"90th_percentile":36184.99},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7129.18,"10th_percentile":7129.18,"90th_percentile":8333.73,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":7642.74,"10th_percentile":7642.74,"90th_percentile":7642.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6884.99,"maximum":12048.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7022.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11465.72},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9983.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12048.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7091.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7229.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6884.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":5243.62,"10th_percentile":5243.62,"90th_percentile":5243.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":7377.45,"10th_percentile":7377.45,"90th_percentile":7377.45},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":154.68,"10th_percentile":154.68,"90th_percentile":154.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7857.48,"maximum":13750.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8014.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12065.28},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11393.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13750.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8093.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8250.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7857.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":10944.81,"10th_percentile":10944.81,"90th_percentile":13147.83,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":3569.8,"10th_percentile":3569.8,"90th_percentile":7825.34,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":9826.38,"10th_percentile":9826.38,"90th_percentile":9826.38},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14568.11,"10th_percentile":14568.11,"90th_percentile":14568.11,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":237.26,"10th_percentile":237.26,"90th_percentile":237.26,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":326.49,"10th_percentile":326.49,"90th_percentile":326.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14388.3,"maximum":25179.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14676.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":23285.16},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20863.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25179.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14819.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15107.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14388.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":15153.25,"10th_percentile":15153.25,"90th_percentile":15153.25,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":8953.35,"10th_percentile":8953.35,"90th_percentile":8953.35},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1521.34,"10th_percentile":1521.34,"90th_percentile":1521.34,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11773.04,"maximum":20948.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12008.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20948.36},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17070.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20602.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12126.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12361.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11773.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15251.21,"10th_percentile":15251.21,"90th_percentile":15251.21,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15177.33,"10th_percentile":15177.33,"90th_percentile":15177.33,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16437.54,"10th_percentile":16437.54,"90th_percentile":17113.76,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10221.01,"maximum":17886.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10425.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":17679.61},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14820.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17886.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10527.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10732.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10221.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6240.73,"10th_percentile":3469.88,"90th_percentile":13888.86,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"12","median_amount":14359.0,"10th_percentile":3389.84,"90th_percentile":18623.14,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"14","median_amount":10064.07,"10th_percentile":3618.81,"90th_percentile":24765.69,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":19276.4,"10th_percentile":13316.63,"90th_percentile":67986.74},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":10886.07,"10th_percentile":10886.07,"90th_percentile":10886.07,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2581.05,"10th_percentile":2581.05,"90th_percentile":2581.05,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12406.97,"10th_percentile":1202.52,"90th_percentile":27240.19,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5852.68,"10th_percentile":5852.68,"90th_percentile":17696.14,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4236.37,"10th_percentile":4236.37,"90th_percentile":4236.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":47798.38,"10th_percentile":47798.38,"90th_percentile":47798.38,"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."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15185.9,"maximum":26575.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15489.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22532.57},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22019.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26575.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15641.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15945.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15185.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7836.26,"maximum":14917.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7992.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14917.6},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11362.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13713.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8071.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8228.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7836.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":425.06,"10th_percentile":425.06,"90th_percentile":425.06,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4514.13,"maximum":7899.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4604.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":7828.2},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6545.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7899.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4649.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4739.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4514.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":10898.13,"10th_percentile":10898.13,"90th_percentile":15936.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":224.9,"10th_percentile":224.9,"90th_percentile":224.9},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10358.58,"maximum":18161.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10565.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18161.27},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15019.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18127.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10669.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10876.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10358.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12769.68,"maximum":22346.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13025.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22336.89},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18516.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22346.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13152.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13408.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12769.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16062.32,"10th_percentile":16062.32,"90th_percentile":16062.32,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":31203.46,"10th_percentile":30861.34,"90th_percentile":36718.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17138.25,"10th_percentile":17138.25,"90th_percentile":17138.25,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6459.84,"maximum":11304.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6589.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11065.59},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9366.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11304.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6653.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6782.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6459.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":12689.05,"10th_percentile":12689.05,"90th_percentile":12689.05,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":14252.0,"10th_percentile":4143.75,"90th_percentile":19919.51,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":10126.91,"10th_percentile":10126.91,"90th_percentile":34475.85},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9452.71,"10th_percentile":9452.71,"90th_percentile":9452.71,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":20357.28,"10th_percentile":20357.28,"90th_percentile":20357.28},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9765.29,"10th_percentile":9765.29,"90th_percentile":9765.29,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30708.4,"maximum":55568.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31322.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":55568.8},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44527.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53739.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31629.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32243.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":30708.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14009.26,"maximum":24516.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14289.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":23799.43},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20313.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24516.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14429.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14709.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14009.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":32590.74,"10th_percentile":32590.74,"90th_percentile":32590.74,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":72228.04,"10th_percentile":72228.04,"90th_percentile":72228.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8558.49,"maximum":15290.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8729.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15290.14},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12409.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14977.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8815.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8986.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8558.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26877.72,"maximum":48427.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27415.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":48427.96},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38972.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47036.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27684.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28221.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":26877.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":70051.54,"10th_percentile":70051.54,"90th_percentile":70051.54,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10854.7,"maximum":20672.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11071.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20672.41},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15739.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18995.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11180.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11397.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":10854.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14373.66,"maximum":27374.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14661.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":27374.24},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20841.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25153.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14804.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15092.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14373.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18447.45,"10th_percentile":18447.45,"90th_percentile":18447.45,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28093.88,"maximum":49965.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28655.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":49965.76},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40736.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49164.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28936.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29498.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":28093.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":62015.25,"10th_percentile":62015.25,"90th_percentile":62015.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37308.07,"10th_percentile":37308.07,"90th_percentile":43316.55,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":82132.54,"10th_percentile":82132.54,"90th_percentile":82132.54,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40799.7,"10th_percentile":40799.7,"90th_percentile":40799.7,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14599.77,"maximum":25549.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14891.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":25299.59},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21169.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25549.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15037.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15329.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14599.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18200.59,"10th_percentile":18200.59,"90th_percentile":18200.59,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":1055.4,"10th_percentile":1055.4,"90th_percentile":1055.4,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":36553.25,"10th_percentile":36553.25,"90th_percentile":36553.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":72898.18,"10th_percentile":72898.18,"90th_percentile":72898.18},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":168.63,"10th_percentile":168.63,"90th_percentile":168.63,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9605.61,"maximum":16809.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9797.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":15907.26},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13928.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16809.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9893.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10085.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9605.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":16627.41,"10th_percentile":16627.41,"90th_percentile":16627.41,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":41811.12,"10th_percentile":41811.12,"90th_percentile":41811.12},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":196.68,"10th_percentile":196.68,"90th_percentile":196.68,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11961.1,"maximum":20931.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12200.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20297.37},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17343.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20931.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12319.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12559.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11961.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6479.6,"maximum":11493.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6609.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11493.32},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9395.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11339.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6673.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6803.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6479.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":60080.42,"10th_percentile":60080.42,"90th_percentile":60080.42},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12305.02,"maximum":21797.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12551.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":21797.54},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17842.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21533.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12674.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12920.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12305.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":24311.43,"10th_percentile":24311.43,"90th_percentile":24311.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4875.62,"maximum":8532.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4973.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8328.67},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7069.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8532.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5021.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5119.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4875.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":12670.78,"10th_percentile":12670.78,"90th_percentile":12670.78,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7590.4,"10th_percentile":7590.4,"90th_percentile":7590.4,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11476.69,"maximum":20565.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11706.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20565.8},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16641.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20084.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11820.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12050.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11476.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19055.34,"10th_percentile":19055.34,"90th_percentile":19055.34,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":29057.65,"10th_percentile":29057.65,"90th_percentile":29611.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":18079.88,"10th_percentile":18079.88,"90th_percentile":18079.88},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":17016.58,"10th_percentile":17016.58,"90th_percentile":17016.58,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15426.03,"10th_percentile":15426.03,"90th_percentile":16597.12,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6271.79,"maximum":11093.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6397.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11093.19},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9094.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10975.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6459.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6585.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6271.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":3217.5,"10th_percentile":3217.5,"90th_percentile":3217.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":10948.21,"10th_percentile":10948.21,"90th_percentile":11422.99,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":3754.8,"10th_percentile":806.61,"90th_percentile":51123.89,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":7072.87,"10th_percentile":7072.87,"90th_percentile":87157.75},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13396.78,"maximum":23444.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13664.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":22871.23},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19425.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23444.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13798.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14066.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":13396.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18944.42,"10th_percentile":18944.42,"90th_percentile":18944.42,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":32717.34,"10th_percentile":32717.34,"90th_percentile":32717.34,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19339.59,"10th_percentile":19339.59,"90th_percentile":19339.59,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":52328.87,"10th_percentile":52328.87,"90th_percentile":52328.87},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7334.28,"maximum":12834.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7480.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12741.36},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10634.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12834.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7554.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7700.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7334.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":33409.63,"10th_percentile":33409.63,"90th_percentile":33409.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8304.52,"10th_percentile":8304.52,"90th_percentile":8304.52,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":21023.56,"10th_percentile":21023.56,"90th_percentile":21023.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":27710.36,"10th_percentile":27710.36,"90th_percentile":27710.36},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11103.85,"10th_percentile":11103.85,"90th_percentile":11103.85,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":41725.12,"10th_percentile":41725.12,"90th_percentile":41725.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5037.33,"maximum":8815.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5138.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":8624.69},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7304.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8815.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5188.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5289.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5037.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12801.14,"maximum":22402.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13057.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":21187.94},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18561.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22402.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13185.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13441.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12801.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":167.53,"10th_percentile":167.53,"90th_percentile":167.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15332.47,"10th_percentile":15332.47,"90th_percentile":15332.47,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7446.97,"maximum":13032.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7595.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12791.53},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10798.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13032.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7670.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7819.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":7446.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":14044.25,"10th_percentile":14044.25,"90th_percentile":14044.25,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12634.57,"10th_percentile":12634.57,"90th_percentile":12634.57,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":156231.18,"maximum":297559.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":159355.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":297559.35},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":226535.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":273404.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":160918.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":164042.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":156231.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52485.86,"maximum":91850.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53535.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":83769.63},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":76104.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":91850.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54060.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55110.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":52485.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23568.04,"maximum":41244.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24039.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":39889.82},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34173.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41244.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24275.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24746.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":23568.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28495.61,"maximum":54270.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29065.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":54270.58},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41318.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49867.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29350.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29920.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":28495.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16175.95,"maximum":28307.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16499.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":26913.9},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23455.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28307.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16661.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16984.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":16175.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19652.75,"10th_percentile":19652.75,"90th_percentile":19652.75,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15073.94,"maximum":27548.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15375.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":27548.59},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21857.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26379.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15526.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15827.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":15073.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26551.36,"maximum":46464.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27082.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":39809.54},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38499.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46464.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27347.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27878.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":26551.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17100.15,"maximum":29925.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17442.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":26482.42},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24795.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29925.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17613.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17955.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":17100.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":259391.98,"10th_percentile":259391.98,"90th_percentile":259391.98},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14837.59,"maximum":25965.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15134.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":24511.88},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21514.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25965.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15282.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15579.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":14837.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11331.8,"maximum":19830.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11558.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":19145.91},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16431.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19830.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11671.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11898.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11331.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8391.65,"maximum":14685.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8559.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14003.21},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12167.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14685.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8643.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8811.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8391.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9288.77,"maximum":16255.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9474.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":16131.78},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13468.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16255.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9567.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9753.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9288.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":24259.27,"10th_percentile":24259.27,"90th_percentile":24259.27,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":20414.2,"10th_percentile":20414.2,"90th_percentile":20414.2,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5857.62,"maximum":10250.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5974.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":9965.56},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8493.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10250.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6033.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6150.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":5857.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":167.53,"10th_percentile":167.53,"90th_percentile":8385.43,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":11783.56,"10th_percentile":11783.56,"90th_percentile":11783.56,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":23369.58,"10th_percentile":23369.58,"90th_percentile":23369.58,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":16478.91,"10th_percentile":16478.91,"90th_percentile":16478.91},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6843.2,"10th_percentile":6843.2,"90th_percentile":6843.2,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":172.63,"10th_percentile":172.63,"90th_percentile":172.63,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8673.26,"10th_percentile":7574.51,"90th_percentile":8698.72,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10069.22,"10th_percentile":8879.8,"90th_percentile":11245.36,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8705.57,"maximum":15234.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8879.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":13532.84},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12623.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15234.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8966.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9140.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8705.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32357.91,"10th_percentile":32357.91,"90th_percentile":32357.91,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":39965.9,"10th_percentile":39965.9,"90th_percentile":39965.9},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4593.16,"maximum":8038.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4685.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":7351.56},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6660.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8038.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4730.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4822.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4593.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4068.5,"maximum":7119.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4149.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":7110.73},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5899.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7119.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4190.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4271.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":4068.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49254.48,"maximum":86195.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50239.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":85643.58},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":71419.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":86195.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50732.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51717.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":49254.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27535.56,"maximum":48187.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28086.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":47942.54},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39926.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48187.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28361.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28912.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":27535.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":66565.59,"10th_percentile":66565.59,"90th_percentile":66565.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":311527.96,"10th_percentile":311527.96,"90th_percentile":311527.96},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37440.19,"10th_percentile":37440.19,"90th_percentile":37440.19,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":27082.9,"10th_percentile":27082.9,"90th_percentile":27082.9,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55758.23,"maximum":97576.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56873.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":93618.53},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":80849.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":97576.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57430.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58546.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":55758.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":129611.91,"10th_percentile":129611.91,"90th_percentile":131400.47,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":499174.37,"10th_percentile":499174.37,"90th_percentile":499174.37},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":567.98,"10th_percentile":567.98,"90th_percentile":567.98,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Cc","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30835.0,"maximum":53961.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31451.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":51546.2},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44710.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53961.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31760.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32376.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":30835.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":56900.4,"10th_percentile":56900.4,"90th_percentile":56900.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":245308.65,"10th_percentile":245308.65,"90th_percentile":245308.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21543.3,"maximum":37700.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21974.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":33160.4},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31237.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37700.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22189.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22620.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":21543.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":46786.79,"10th_percentile":46786.79,"90th_percentile":46786.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20004.44,"maximum":35007.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20404.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":34074.8},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29006.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35007.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20604.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21004.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":20004.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26077.68,"10th_percentile":26077.68,"90th_percentile":26077.68,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11214.72,"maximum":19625.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11439.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18817.28},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16261.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19625.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11551.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11775.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":11214.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":117642.89,"10th_percentile":117642.89,"90th_percentile":117642.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":20301.43,"10th_percentile":20301.43,"90th_percentile":20301.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13039.73,"10th_percentile":13039.73,"90th_percentile":13039.73,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":170.79,"10th_percentile":170.79,"90th_percentile":170.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6882.06,"maximum":12043.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7019.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":11445.65},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9978.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12043.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7088.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7226.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6882.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":16462.11,"10th_percentile":16462.11,"90th_percentile":16462.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44792.3,"maximum":79321.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45688.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":79321.82},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":64948.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":78386.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46136.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47031.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":44792.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19299.04,"maximum":33773.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19685.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":33279.57},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27983.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33773.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19878.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20263.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":19299.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27077.61,"10th_percentile":27077.61,"90th_percentile":27077.61,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21118.16,"maximum":37453.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21540.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":37453.94},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30621.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36956.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21751.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22174.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":21118.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12654.77,"10th_percentile":12654.77,"90th_percentile":12654.77,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":124242.25,"10th_percentile":123914.54,"90th_percentile":188907.27},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28797.72,"10th_percentile":28797.72,"90th_percentile":28797.72,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28920.44,"10th_percentile":28920.44,"90th_percentile":30315.74,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":53433.92,"10th_percentile":53433.92,"90th_percentile":53433.92,"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":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9476.1,"maximum":17827.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9665.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":17827.62},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13740.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16583.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9760.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9949.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9476.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":14149.08,"10th_percentile":14149.08,"90th_percentile":14149.08,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12782.68,"10th_percentile":12782.68,"90th_percentile":14843.55,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6605.46,"maximum":12579.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6737.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":12579.56},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9577.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11559.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6803.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6935.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":6605.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9495.85,"maximum":18084.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9685.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":18084.76},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13768.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16617.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9780.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9970.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":9495.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":28652.82,"10th_percentile":28652.82,"90th_percentile":28652.82,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34332.0,"maximum":60081.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35018.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":59634.04},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49781.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60081.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35361.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36048.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":34332.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46558.77,"10th_percentile":46558.77,"90th_percentile":46772.76,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":87560.2,"10th_percentile":87560.2,"90th_percentile":87560.2,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":99024.28,"10th_percentile":99024.28,"90th_percentile":99024.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":118185.29,"10th_percentile":118185.29,"90th_percentile":118185.29},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49831.7,"10th_percentile":49831.7,"90th_percentile":49831.7,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":727.55,"10th_percentile":727.55,"90th_percentile":727.55,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"1 through 10","median_amount":85987.96,"10th_percentile":85987.96,"90th_percentile":85987.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17989.95,"maximum":31482.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18349.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":30711.98},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26085.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31482.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18529.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18889.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":17989.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22222.21,"10th_percentile":22222.21,"90th_percentile":22222.21,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"1 through 10","median_amount":39579.36,"10th_percentile":39579.36,"90th_percentile":39579.36,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24690.77,"10th_percentile":24690.77,"90th_percentile":24690.77,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32189.69,"10th_percentile":32189.69,"90th_percentile":32189.69,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12542.11,"maximum":21948.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12792.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":20923.28},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18186.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21948.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12918.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13169.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12542.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":24791.8,"10th_percentile":24791.8,"90th_percentile":24791.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25087.14,"maximum":43938.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25588.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":43938.76},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36376.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43902.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25839.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26341.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":25087.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32515.25,"10th_percentile":32515.25,"90th_percentile":32515.25,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35013.37,"10th_percentile":35013.37,"90th_percentile":35013.37,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12026.96,"maximum":21524.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12267.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":21524.1},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17439.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21047.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12387.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12628.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":12026.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"1 through 10","median_amount":30913.14,"10th_percentile":30913.14,"90th_percentile":30913.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17461.66,"10th_percentile":17461.66,"90th_percentile":17461.66,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8775.08,"maximum":15356.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8950.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"fee schedule","standard_charge_dollar":14492.39},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12723.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15356.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9038.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9213.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":8775.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"169","median_amount":272.97,"10th_percentile":85.3,"90th_percentile":1414.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1852","median_amount":195.02,"10th_percentile":134.22,"90th_percentile":622.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"460","median_amount":300.78,"10th_percentile":196.01,"90th_percentile":1043.98,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"60","median_amount":281.84,"10th_percentile":89.86,"90th_percentile":728.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"836","median_amount":337.67,"10th_percentile":164.25,"90th_percentile":986.05,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"144","median_amount":112.35,"10th_percentile":34.41,"90th_percentile":231.35,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1464","median_amount":205.45,"10th_percentile":65.26,"90th_percentile":1078.2},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"1 through 10","median_amount":105.16,"10th_percentile":105.16,"90th_percentile":402.82},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"125","median_amount":97.23,"10th_percentile":34.07,"90th_percentile":392.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"129","median_amount":188.28,"10th_percentile":69.3,"90th_percentile":1122.89,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"352","median_amount":222.11,"10th_percentile":180.63,"90th_percentile":640.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":367.13,"10th_percentile":180.99,"90th_percentile":589.05},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1518","median_amount":201.89,"10th_percentile":137.96,"90th_percentile":651.48,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"287","median_amount":299.0,"10th_percentile":101.71,"90th_percentile":1231.14},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"255","median_amount":205.7,"10th_percentile":134.08,"90th_percentile":876.15,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"249","median_amount":77.95,"10th_percentile":33.99,"90th_percentile":370.44,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"404","median_amount":349.01,"10th_percentile":130.81,"90th_percentile":1451.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":101.47,"10th_percentile":101.47,"90th_percentile":101.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":121.54,"10th_percentile":57.41,"90th_percentile":310.77,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":139.72,"10th_percentile":74.23,"90th_percentile":243.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":278.57,"10th_percentile":208.93,"90th_percentile":332.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"11","median_amount":155.51,"10th_percentile":144.57,"90th_percentile":210.95,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"16","median_amount":337.61,"10th_percentile":129.33,"90th_percentile":427.96},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"1 through 10","median_amount":54.92,"10th_percentile":54.92,"90th_percentile":54.92},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"11","median_amount":138.37,"10th_percentile":87.22,"90th_percentile":151.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":1041.5,"10th_percentile":1041.5,"90th_percentile":1041.5,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":94.27,"10th_percentile":94.27,"90th_percentile":94.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":159.18,"10th_percentile":159.18,"90th_percentile":159.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"29","median_amount":140.11,"10th_percentile":107.22,"90th_percentile":159.8,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"13","median_amount":205.2,"10th_percentile":78.33,"90th_percentile":414.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"12","median_amount":568.8,"10th_percentile":288.33,"90th_percentile":1056.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"32","median_amount":208.2,"10th_percentile":172.31,"90th_percentile":280.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"63","median_amount":255.38,"10th_percentile":169.0,"90th_percentile":492.07,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":304.73,"10th_percentile":304.73,"90th_percentile":304.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"96","median_amount":304.94,"10th_percentile":194.41,"90th_percentile":460.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"111","median_amount":281.71,"10th_percentile":164.87,"90th_percentile":389.78,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"98","median_amount":621.21,"10th_percentile":249.86,"90th_percentile":1193.6},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":643.2,"10th_percentile":507.89,"90th_percentile":1562.7,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":925.97,"10th_percentile":684.87,"90th_percentile":2241.61},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":280.22,"10th_percentile":262.9,"90th_percentile":280.22,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"227","median_amount":156.97,"10th_percentile":78.33,"90th_percentile":292.2,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"42","median_amount":647.42,"10th_percentile":375.04,"90th_percentile":1228.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"103","median_amount":1268.89,"10th_percentile":450.65,"90th_percentile":2442.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"421","median_amount":391.31,"10th_percentile":285.39,"90th_percentile":676.52,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1205","median_amount":140.11,"10th_percentile":128.92,"90th_percentile":685.14,"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."}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"137","median_amount":3698.03,"10th_percentile":805.75,"90th_percentile":8616.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"902","median_amount":813.95,"10th_percentile":552.35,"90th_percentile":1222.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"189","median_amount":4132.25,"10th_percentile":678.76,"90th_percentile":9976.96},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"192","median_amount":887.49,"10th_percentile":650.1,"90th_percentile":1176.35,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"782","median_amount":185.76,"10th_percentile":125.78,"90th_percentile":1374.21,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"496","median_amount":3349.47,"10th_percentile":917.71,"90th_percentile":9069.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"15","median_amount":10206.83,"10th_percentile":3619.47,"90th_percentile":14099.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"153","median_amount":2548.75,"10th_percentile":1951.25,"90th_percentile":2955.22,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"41","median_amount":1124.21,"10th_percentile":771.04,"90th_percentile":4717.56,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"128","median_amount":9817.59,"10th_percentile":3551.18,"90th_percentile":19595.81},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":5663.56,"10th_percentile":3108.75,"90th_percentile":12921.85,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":2910.0,"10th_percentile":1000.6,"90th_percentile":3100.54,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"127","median_amount":2865.89,"10th_percentile":1202.33,"90th_percentile":3129.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"14","median_amount":14229.78,"10th_percentile":5030.68,"90th_percentile":16472.02},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":2922.33,"10th_percentile":2754.73,"90th_percentile":3360.79,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"75","median_amount":1405.33,"10th_percentile":200.31,"90th_percentile":3817.54,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"48","median_amount":9553.56,"10th_percentile":2915.6,"90th_percentile":18182.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":14911.04,"10th_percentile":2880.51,"90th_percentile":28810.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"34","median_amount":1583.77,"10th_percentile":1054.86,"90th_percentile":2934.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"24","median_amount":1519.17,"10th_percentile":303.2,"90th_percentile":3959.94,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3219.93,"10th_percentile":3219.93,"90th_percentile":3219.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":3370.65,"10th_percentile":2205.59,"90th_percentile":5174.51,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"23","median_amount":2307.34,"10th_percentile":1369.25,"90th_percentile":6711.08,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"36","median_amount":7002.37,"10th_percentile":2784.55,"90th_percentile":15240.19},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":23705.31,"10th_percentile":23705.31,"90th_percentile":23705.31,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1857.14,"10th_percentile":1544.47,"90th_percentile":3217.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":2937.78,"10th_percentile":1388.02,"90th_percentile":3300.82,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":19435.62,"10th_percentile":19435.62,"90th_percentile":19435.62},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1531.79,"10th_percentile":1374.98,"90th_percentile":3089.9,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"43","median_amount":1544.36,"10th_percentile":888.16,"90th_percentile":5419.92,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"23","median_amount":10165.87,"10th_percentile":2015.74,"90th_percentile":25875.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":1016.23,"10th_percentile":246.92,"90th_percentile":2216.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":667.27,"10th_percentile":224.84,"90th_percentile":1087.24,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"23","median_amount":648.26,"10th_percentile":293.31,"90th_percentile":1076.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":494.18,"10th_percentile":494.18,"90th_percentile":494.18,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"42","median_amount":691.84,"10th_percentile":434.15,"90th_percentile":1494.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"19","median_amount":536.16,"10th_percentile":430.96,"90th_percentile":1288.68,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"35","median_amount":1476.52,"10th_percentile":428.49,"90th_percentile":3160.22},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":1239.83,"10th_percentile":1057.91,"90th_percentile":19495.66,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":387.94,"10th_percentile":373.64,"90th_percentile":1152.96,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":413.72,"10th_percentile":193.13,"90th_percentile":1250.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":2085.82,"10th_percentile":1546.6,"90th_percentile":8767.37},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":566.95,"10th_percentile":454.12,"90th_percentile":3229.14,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"76","median_amount":532.28,"10th_percentile":401.71,"90th_percentile":972.17,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"21","median_amount":1419.15,"10th_percentile":534.4,"90th_percentile":2579.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":469.37,"10th_percentile":469.37,"90th_percentile":2046.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"52","median_amount":802.37,"10th_percentile":406.17,"90th_percentile":2050.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":1267.76,"10th_percentile":784.04,"90th_percentile":5950.74,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1344.16,"10th_percentile":1344.16,"90th_percentile":1344.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":1522.72,"10th_percentile":727.44,"90th_percentile":7607.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6354.71,"10th_percentile":6354.71,"90th_percentile":6354.71,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"21","median_amount":1943.18,"10th_percentile":617.16,"90th_percentile":13061.14},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":646.79,"10th_percentile":646.79,"90th_percentile":646.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":1109.05,"10th_percentile":642.05,"90th_percentile":1984.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"32","median_amount":1043.08,"10th_percentile":652.75,"90th_percentile":3722.02,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":2856.18,"10th_percentile":2856.18,"90th_percentile":17210.51},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2695.04,"10th_percentile":2695.04,"90th_percentile":2695.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":640.79,"10th_percentile":314.28,"90th_percentile":4981.42,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":7875.14,"10th_percentile":2776.18,"90th_percentile":30180.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":636.62,"10th_percentile":636.62,"90th_percentile":1188.37,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":987.15,"10th_percentile":987.15,"90th_percentile":987.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2514.01,"10th_percentile":2514.01,"90th_percentile":2514.01,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":954.56,"10th_percentile":954.56,"90th_percentile":1431.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":8319.57,"10th_percentile":2422.51,"90th_percentile":8394.94},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2380.77,"10th_percentile":2380.77,"90th_percentile":4268.61,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":784.96,"10th_percentile":616.14,"90th_percentile":1008.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":11652.23,"10th_percentile":11652.23,"90th_percentile":11652.23},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1013.15,"10th_percentile":1013.15,"90th_percentile":1013.15,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1547.51,"10th_percentile":1547.51,"90th_percentile":1547.51,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1736.86,"10th_percentile":1558.89,"90th_percentile":1940.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":2714.05,"10th_percentile":2714.05,"90th_percentile":2714.05,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3799.81,"10th_percentile":3799.81,"90th_percentile":3799.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1585.25,"10th_percentile":1585.25,"90th_percentile":1585.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1967.35,"10th_percentile":1967.35,"90th_percentile":1967.35,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":26526.24,"10th_percentile":26526.24,"90th_percentile":26526.24},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1808.84,"10th_percentile":1808.84,"90th_percentile":1808.84,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":37612.8,"10th_percentile":37612.8,"90th_percentile":37612.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Skin Procedures","code_information":[{"code":"5055","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":53513.16,"10th_percentile":53513.16,"90th_percentile":53513.16},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyperbaric Oxygen","code_information":[{"code":"5061","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19555.26,"10th_percentile":14491.97,"90th_percentile":21260.84,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1884.96,"10th_percentile":1496.36,"90th_percentile":59935.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":103055.98,"10th_percentile":103055.98,"90th_percentile":103055.98},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":146508.95,"10th_percentile":146508.95,"90th_percentile":146508.95,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15606.36,"10th_percentile":2575.96,"90th_percentile":20414.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":116827.54,"10th_percentile":116827.54,"90th_percentile":116827.54},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6886.68,"10th_percentile":1507.21,"90th_percentile":32271.92,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":1749.64,"10th_percentile":852.44,"90th_percentile":3003.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":585.39,"10th_percentile":359.34,"90th_percentile":801.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":1134.65,"10th_percentile":792.92,"90th_percentile":7020.22,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":796.07,"10th_percentile":796.07,"90th_percentile":1397.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1072.51,"10th_percentile":331.19,"90th_percentile":1921.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":604.82,"10th_percentile":581.31,"90th_percentile":3533.75,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"21","median_amount":2296.35,"10th_percentile":866.45,"90th_percentile":4870.08},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":2156.27,"10th_percentile":2156.27,"90th_percentile":5401.76,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":378.99,"10th_percentile":375.0,"90th_percentile":818.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":4044.3,"10th_percentile":4044.3,"90th_percentile":4044.3},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":617.52,"10th_percentile":312.25,"90th_percentile":685.99,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":3569.67,"10th_percentile":3569.67,"90th_percentile":8186.07},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":732.02,"10th_percentile":732.02,"90th_percentile":732.02,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":777.91,"10th_percentile":777.91,"90th_percentile":2678.07,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":2795.2,"10th_percentile":1664.64,"90th_percentile":4086.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"15","median_amount":5460.8,"10th_percentile":2169.78,"90th_percentile":14456.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"72","median_amount":1387.88,"10th_percentile":1319.5,"90th_percentile":1767.88,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"18","median_amount":2057.01,"10th_percentile":1802.31,"90th_percentile":2612.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2464.29,"10th_percentile":1955.43,"90th_percentile":2519.56,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"60","median_amount":2380.23,"10th_percentile":1475.0,"90th_percentile":3010.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2159.55,"10th_percentile":1899.64,"90th_percentile":4860.82,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"107","median_amount":6107.04,"10th_percentile":2752.05,"90th_percentile":14275.83},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"1 through 10","median_amount":10953.13,"10th_percentile":10953.13,"90th_percentile":10953.13},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"12","median_amount":6744.98,"10th_percentile":3850.8,"90th_percentile":14874.93,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1736.29,"10th_percentile":1436.29,"90th_percentile":2729.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"73","median_amount":1593.18,"10th_percentile":1293.61,"90th_percentile":2845.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"29","median_amount":5590.26,"10th_percentile":3996.5,"90th_percentile":24518.61},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1685.72,"10th_percentile":1628.08,"90th_percentile":1887.85,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"15","median_amount":2059.9,"10th_percentile":1529.68,"90th_percentile":2625.12,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"23","median_amount":5333.22,"10th_percentile":2856.8,"90th_percentile":13422.39,"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":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":17895.2,"10th_percentile":13776.92,"90th_percentile":19412.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"45","median_amount":2980.46,"10th_percentile":2381.21,"90th_percentile":5996.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":3212.86,"10th_percentile":324.73,"90th_percentile":5041.05,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3258.56,"10th_percentile":3258.56,"90th_percentile":3258.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":5271.73,"10th_percentile":5211.01,"90th_percentile":17052.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":20656.4,"10th_percentile":20656.4,"90th_percentile":30535.49,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":2764.01,"10th_percentile":2752.84,"90th_percentile":13350.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"39","median_amount":3035.99,"10th_percentile":2623.08,"90th_percentile":3952.48,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":15480.56,"10th_percentile":14471.34,"90th_percentile":21124.31},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2977.71,"10th_percentile":693.27,"90th_percentile":3048.96,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3556.67,"10th_percentile":1722.33,"90th_percentile":7008.51,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":13563.44,"10th_percentile":12958.65,"90th_percentile":36844.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":26956.38,"10th_percentile":26956.38,"90th_percentile":26956.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":3991.54,"10th_percentile":3610.04,"90th_percentile":6789.91,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":5357.8,"10th_percentile":5357.8,"90th_percentile":5357.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4399.36,"10th_percentile":4399.36,"90th_percentile":4399.36,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6972.05,"10th_percentile":6374.9,"90th_percentile":11873.75,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6495.74,"10th_percentile":6495.74,"90th_percentile":8525.21,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"16","median_amount":21146.17,"10th_percentile":12591.86,"90th_percentile":39757.59},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":20460.0,"10th_percentile":20460.0,"90th_percentile":24820.67,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3728.55,"10th_percentile":3728.55,"90th_percentile":3728.55,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6414.86,"10th_percentile":3658.57,"90th_percentile":12549.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":34002.71,"10th_percentile":34002.71,"90th_percentile":34002.71},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":26078.4,"10th_percentile":17260.67,"90th_percentile":62242.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5092","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":38841.03,"10th_percentile":7987.58,"90th_percentile":60903.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6691.3,"10th_percentile":6115.25,"90th_percentile":8859.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":10516.77,"10th_percentile":9517.84,"90th_percentile":15084.68,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8854.43,"10th_percentile":8854.43,"90th_percentile":8854.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11179.32,"10th_percentile":10780.4,"90th_percentile":41497.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":8525.21,"10th_percentile":8525.21,"90th_percentile":8525.21,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"16","median_amount":59007.4,"10th_percentile":23901.38,"90th_percentile":210690.57},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":55325.12,"10th_percentile":55325.12,"90th_percentile":55325.12,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":60180.27,"10th_percentile":60180.27,"90th_percentile":60180.27},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6990.76,"10th_percentile":5585.41,"90th_percentile":10128.77,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":50565.77,"10th_percentile":50565.77,"90th_percentile":50565.77},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":7785.27,"10th_percentile":7781.9,"90th_percentile":8364.3,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":57767.97,"10th_percentile":49816.94,"90th_percentile":96161.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5093","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":85703.29,"10th_percentile":85703.29,"90th_percentile":85703.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21238.32,"10th_percentile":21238.32,"90th_percentile":21238.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":306265.73,"10th_percentile":306265.73,"90th_percentile":306265.73},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13956.6,"10th_percentile":13956.6,"90th_percentile":13956.6,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":158329.09,"10th_percentile":158329.09,"90th_percentile":158329.09},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5094","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":39094.02,"10th_percentile":39094.02,"90th_percentile":39094.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":166516.14,"10th_percentile":101752.67,"90th_percentile":220888.61},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":65296.4,"10th_percentile":65296.4,"90th_percentile":65296.4,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":139334.09,"10th_percentile":139334.09,"90th_percentile":170699.26},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":958.03,"10th_percentile":298.11,"90th_percentile":2648.26,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":1916.49,"10th_percentile":953.05,"90th_percentile":3995.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":477.4,"10th_percentile":477.4,"90th_percentile":477.4,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1035.07,"10th_percentile":682.25,"90th_percentile":2973.6,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":8805.58,"10th_percentile":8805.58,"90th_percentile":8805.58,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":993.42,"10th_percentile":490.91,"90th_percentile":2959.86},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":39108.79,"10th_percentile":39108.79,"90th_percentile":39108.79,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2818.2,"10th_percentile":2818.2,"90th_percentile":2818.2,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":671.55,"10th_percentile":478.05,"90th_percentile":1036.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":2534.65,"10th_percentile":2534.65,"90th_percentile":6256.84},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3204.2,"10th_percentile":3204.2,"90th_percentile":3204.2,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":557.55,"10th_percentile":136.75,"90th_percentile":900.49,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":18132.0,"10th_percentile":3217.28,"90th_percentile":38359.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Strapping and Cast Application","code_information":[{"code":"5102","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1457.09,"10th_percentile":1457.09,"90th_percentile":1457.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":1770.28,"10th_percentile":1770.28,"90th_percentile":1770.28,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2156.94,"10th_percentile":2156.94,"90th_percentile":2156.94,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":12256.14,"10th_percentile":12256.14,"90th_percentile":12256.14},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":916.23,"10th_percentile":916.23,"90th_percentile":916.23,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":1841.32,"10th_percentile":1841.32,"90th_percentile":2037.97},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":865.29,"10th_percentile":527.47,"90th_percentile":2854.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":474.59,"10th_percentile":472.29,"90th_percentile":661.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":17710.05,"10th_percentile":17710.05,"90th_percentile":17710.05},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"13","median_amount":669.25,"10th_percentile":140.11,"90th_percentile":1301.22,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":2883.43,"10th_percentile":1750.2,"90th_percentile":2951.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":7384.8,"10th_percentile":7384.8,"90th_percentile":7384.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":1552.89,"10th_percentile":1331.53,"90th_percentile":2059.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":1787.37,"10th_percentile":1290.44,"90th_percentile":2426.02,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3085.61,"10th_percentile":3085.61,"90th_percentile":3085.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2411.0,"10th_percentile":1132.49,"90th_percentile":2913.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1405.82,"10th_percentile":1405.82,"90th_percentile":2573.48,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"17","median_amount":6311.21,"10th_percentile":3969.42,"90th_percentile":13076.29},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":4798.72,"10th_percentile":4798.72,"90th_percentile":5324.76,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1715.03,"10th_percentile":1715.03,"90th_percentile":1715.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1680.33,"10th_percentile":1549.61,"90th_percentile":1911.18,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":4700.34,"10th_percentile":4700.34,"90th_percentile":8568.6},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1665.09,"10th_percentile":1665.09,"90th_percentile":1665.09,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1126.78,"10th_percentile":1041.37,"90th_percentile":7582.22,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":7272.96,"10th_percentile":7272.96,"90th_percentile":7272.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":12421.15,"10th_percentile":9995.55,"90th_percentile":22744.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":3001.98,"10th_percentile":2699.5,"90th_percentile":3108.84,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":5232.38,"10th_percentile":3924.29,"90th_percentile":10623.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5152.37,"10th_percentile":5152.37,"90th_percentile":5152.37,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":5077.05,"10th_percentile":4430.65,"90th_percentile":5907.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5056.61,"10th_percentile":4103.95,"90th_percentile":6401.21,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"37","median_amount":14208.5,"10th_percentile":7300.89,"90th_percentile":20791.06},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":9690.37,"10th_percentile":9690.37,"90th_percentile":9690.37,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":3032.63,"10th_percentile":2938.06,"90th_percentile":3446.66,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"13","median_amount":3985.68,"10th_percentile":1784.87,"90th_percentile":5105.46,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":13905.93,"10th_percentile":3185.25,"90th_percentile":27726.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":36015.55,"10th_percentile":22537.6,"90th_percentile":43525.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":7057.06,"10th_percentile":5943.56,"90th_percentile":7171.06,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8867.0,"10th_percentile":8867.0,"90th_percentile":10687.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":12914.14,"10th_percentile":11166.74,"90th_percentile":13286.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":8525.21,"10th_percentile":8525.21,"90th_percentile":8525.21,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7280.4,"10th_percentile":6674.19,"90th_percentile":8030.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":7206.96,"10th_percentile":6118.37,"90th_percentile":7406.96,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"13","median_amount":34952.15,"10th_percentile":24525.29,"90th_percentile":70436.32},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7432.42,"10th_percentile":7432.42,"90th_percentile":7432.42,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"14","median_amount":7785.27,"10th_percentile":7663.84,"90th_percentile":7785.29,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":25660.39,"10th_percentile":15020.92,"90th_percentile":34090.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":53162.52,"10th_percentile":53162.52,"90th_percentile":71082.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":13105.53,"10th_percentile":10779.81,"90th_percentile":13482.37,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":19753.63,"10th_percentile":19662.18,"90th_percentile":20928.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18393.68,"10th_percentile":18393.68,"90th_percentile":18393.68,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":22325.97,"10th_percentile":20441.11,"90th_percentile":23589.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":8818.53,"10th_percentile":8818.53,"90th_percentile":8818.53,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"17","median_amount":52651.76,"10th_percentile":42322.54,"90th_percentile":62420.14},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13884.88,"10th_percentile":13510.09,"90th_percentile":13885.91,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":13430.0,"10th_percentile":11096.86,"90th_percentile":13875.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":59824.03,"10th_percentile":47159.11,"90th_percentile":60140.99},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13480.98,"10th_percentile":13480.17,"90th_percentile":51441.19,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":7785.27,"10th_percentile":7728.2,"90th_percentile":7785.28,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":62314.79,"10th_percentile":60303.19,"90th_percentile":87291.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18852.67,"10th_percentile":18852.67,"90th_percentile":19568.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Airway Endoscopy","code_information":[{"code":"5151","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":256.52,"10th_percentile":213.2,"90th_percentile":771.02,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":780.51,"10th_percentile":780.51,"90th_percentile":780.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":274.17,"10th_percentile":238.63,"90th_percentile":529.15,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":753.35,"10th_percentile":657.37,"90th_percentile":897.39},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":601.3,"10th_percentile":601.3,"90th_percentile":601.3,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":63.9,"10th_percentile":63.9,"90th_percentile":63.9,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":482.94,"10th_percentile":243.92,"90th_percentile":725.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1801.04,"10th_percentile":1421.04,"90th_percentile":3842.02,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":4686.69,"10th_percentile":4686.69,"90th_percentile":4686.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3139.78,"10th_percentile":2372.52,"90th_percentile":3634.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":30728.99,"10th_percentile":30728.99,"90th_percentile":30728.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1850.73,"10th_percentile":1850.73,"90th_percentile":1855.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":11467.56,"10th_percentile":11467.56,"90th_percentile":19491.94},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1794.16,"10th_percentile":1794.16,"90th_percentile":1794.16,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":4723.2,"10th_percentile":4723.2,"90th_percentile":4723.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Airway Endoscopy","code_information":[{"code":"5154","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":16581.6,"10th_percentile":16581.6,"90th_percentile":16581.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":3842.02,"10th_percentile":3311.54,"90th_percentile":6883.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":6213.6,"10th_percentile":4824.37,"90th_percentile":10163.44,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4815.67,"10th_percentile":4815.67,"90th_percentile":5140.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6812.9,"10th_percentile":5034.67,"90th_percentile":12603.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"18","median_amount":16785.71,"10th_percentile":11258.64,"90th_percentile":27501.26},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3951.03,"10th_percentile":3576.03,"90th_percentile":7303.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":5928.86,"10th_percentile":3506.19,"90th_percentile":7151.46,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3835.95,"10th_percentile":3835.95,"90th_percentile":7502.08,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":8493.37,"10th_percentile":8493.37,"90th_percentile":11634.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Airway Endoscopy","code_information":[{"code":"5155","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5759.47,"10th_percentile":5759.47,"90th_percentile":6833.79,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12603.89,"10th_percentile":12603.89,"90th_percentile":12603.89,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4003.87,"10th_percentile":4003.87,"90th_percentile":4003.87,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":19194.06,"10th_percentile":19194.06,"90th_percentile":19194.06},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6970.09,"10th_percentile":6970.09,"90th_percentile":6970.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 ENT Procedures","code_information":[{"code":"5161","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1988.65,"10th_percentile":1900.93,"90th_percentile":2604.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":3097.53,"10th_percentile":1851.28,"90th_percentile":4627.88,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5753.25,"10th_percentile":3226.62,"90th_percentile":12878.98,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1311.02,"10th_percentile":1311.02,"90th_percentile":1311.02,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":10686.72,"10th_percentile":10686.72,"90th_percentile":17147.57},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6958.91,"10th_percentile":6958.91,"90th_percentile":6958.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3142.53,"10th_percentile":1954.36,"90th_percentile":5633.8,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":7368.61,"10th_percentile":7368.61,"90th_percentile":7368.61},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8406.06,"10th_percentile":8406.06,"90th_percentile":11040.35,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2184.23,"10th_percentile":1315.68,"90th_percentile":2349.34,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":10084.41,"10th_percentile":10084.41,"90th_percentile":10084.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 ENT Procedures","code_information":[{"code":"5162","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":927.2,"10th_percentile":927.2,"90th_percentile":927.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 ENT Procedures","code_information":[{"code":"5163","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1540.52,"10th_percentile":1540.52,"90th_percentile":1540.52,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":1878.05,"10th_percentile":1878.05,"90th_percentile":1878.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2198.9,"10th_percentile":2198.9,"90th_percentile":2198.9,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2899.44,"10th_percentile":2553.13,"90th_percentile":3149.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"17","median_amount":2200.56,"10th_percentile":1401.01,"90th_percentile":2377.77,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"19","median_amount":6559.33,"10th_percentile":5094.37,"90th_percentile":10193.88},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":4190.3,"10th_percentile":4190.3,"90th_percentile":7866.66,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1594.84,"10th_percentile":1594.84,"90th_percentile":1594.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":7324.84,"10th_percentile":6917.48,"90th_percentile":7975.35},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":6596.93,"10th_percentile":6596.93,"90th_percentile":16592.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 ENT Procedures","code_information":[{"code":"5164","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":10995.2,"10th_percentile":10995.2,"90th_percentile":10995.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3007.24,"10th_percentile":3007.24,"90th_percentile":3078.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":3922.43,"10th_percentile":3905.08,"90th_percentile":5229.9,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4647.87,"10th_percentile":4647.87,"90th_percentile":4647.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5295.94,"10th_percentile":3815.85,"90th_percentile":6491.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"15","median_amount":3271.44,"10th_percentile":2609.37,"90th_percentile":3989.4,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"22","median_amount":10952.82,"10th_percentile":9260.3,"90th_percentile":22520.68},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":9395.51,"10th_percentile":5972.67,"90th_percentile":14264.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3437.89,"10th_percentile":3437.89,"90th_percentile":3437.89,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":13078.26,"10th_percentile":11936.28,"90th_percentile":13123.0},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":10100.16,"10th_percentile":7210.32,"90th_percentile":24321.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 ENT Procedures","code_information":[{"code":"5165","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":6608.94,"10th_percentile":6608.94,"90th_percentile":42717.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8044.45,"10th_percentile":5898.62,"90th_percentile":11905.14,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":9539.83,"10th_percentile":9539.83,"90th_percentile":9539.83,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"23","median_amount":3518.15,"10th_percentile":2773.74,"90th_percentile":4542.78,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"29","median_amount":12316.96,"10th_percentile":6573.96,"90th_percentile":34093.64},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":12150.34,"10th_percentile":12150.34,"90th_percentile":46455.81,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6339.37,"10th_percentile":6339.37,"90th_percentile":6339.37,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6652.21,"10th_percentile":6342.21,"90th_percentile":10236.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":12651.01,"10th_percentile":9609.32,"90th_percentile":37179.28},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6154.73,"10th_percentile":6154.73,"90th_percentile":6154.73,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"59","median_amount":3436.81,"10th_percentile":2697.21,"90th_percentile":4341.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":18836.46,"10th_percentile":12141.2,"90th_percentile":44065.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":2726.11,"10th_percentile":2726.11,"90th_percentile":2808.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":637.29,"10th_percentile":362.15,"90th_percentile":1520.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":2413.07,"10th_percentile":173.19,"90th_percentile":12154.54,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":1125.69,"10th_percentile":748.02,"90th_percentile":1992.6,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":2781.6,"10th_percentile":2781.6,"90th_percentile":2910.4,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":662.54,"10th_percentile":362.54,"90th_percentile":1472.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":661.9,"10th_percentile":220.9,"90th_percentile":1627.57,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":2712.06,"10th_percentile":2419.56,"90th_percentile":4403.88},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1046.79,"10th_percentile":1046.79,"90th_percentile":1046.79,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"12","median_amount":698.12,"10th_percentile":516.33,"90th_percentile":1218.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":2525.58,"10th_percentile":2487.66,"90th_percentile":10579.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":73593.55,"10th_percentile":73593.55,"90th_percentile":73593.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":3431.28,"10th_percentile":1292.44,"90th_percentile":116163.02,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":1878.85,"10th_percentile":1878.85,"90th_percentile":1878.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":25184.29,"10th_percentile":25184.29,"90th_percentile":25184.29,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6009.24,"10th_percentile":4739.4,"90th_percentile":8029.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":8531.81,"10th_percentile":8531.81,"90th_percentile":8531.81,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":58473.87,"10th_percentile":38446.66,"90th_percentile":58473.87},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":24430.88,"10th_percentile":24430.88,"90th_percentile":24430.88,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2088.97,"10th_percentile":2088.97,"90th_percentile":2088.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":158079.63,"10th_percentile":158079.63,"90th_percentile":158079.63},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1936.21,"10th_percentile":1740.16,"90th_percentile":57663.29,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":123971.41,"10th_percentile":66137.6,"90th_percentile":123971.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":13521.65,"10th_percentile":13064.05,"90th_percentile":16107.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"50","median_amount":2907.85,"10th_percentile":2618.71,"90th_percentile":3280.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"15","median_amount":5075.79,"10th_percentile":3580.79,"90th_percentile":5075.79,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4748.32,"10th_percentile":4748.32,"90th_percentile":4748.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":5730.73,"10th_percentile":4933.67,"90th_percentile":5730.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5167.86,"10th_percentile":5167.86,"90th_percentile":5167.86,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"28","median_amount":12855.49,"10th_percentile":10011.4,"90th_percentile":17860.83},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3952.42,"10th_percentile":3415.52,"90th_percentile":5379.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":10147.26,"10th_percentile":10147.26,"90th_percentile":10147.26,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3267.94,"10th_percentile":3047.94,"90th_percentile":3372.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":2968.67,"10th_percentile":2695.73,"90th_percentile":9712.83,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":12052.82,"10th_percentile":10696.4,"90th_percentile":12693.01},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3274.7,"10th_percentile":3274.7,"90th_percentile":3274.7,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3742.93,"10th_percentile":3383.71,"90th_percentile":7435.99,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":14089.66,"10th_percentile":10757.2,"90th_percentile":22037.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Vascular Procedures","code_information":[{"code":"5184","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":28394.94,"10th_percentile":28394.94,"90th_percentile":28394.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":5256.36,"10th_percentile":4497.51,"90th_percentile":5823.95,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":8717.43,"10th_percentile":8717.43,"90th_percentile":8717.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9199.89,"10th_percentile":9199.89,"90th_percentile":9199.89,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":21397.46,"10th_percentile":21397.46,"90th_percentile":21397.46},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":21401.54,"10th_percentile":21401.54,"90th_percentile":21401.54,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5792.87,"10th_percentile":5792.87,"90th_percentile":5792.87,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":5391.25,"10th_percentile":5346.25,"90th_percentile":5787.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":2979.51,"10th_percentile":2686.76,"90th_percentile":3348.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":4831.77,"10th_percentile":4831.77,"90th_percentile":4831.77,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3639.2,"10th_percentile":3639.2,"90th_percentile":3639.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6149.5,"10th_percentile":4392.15,"90th_percentile":7914.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"11","median_amount":15065.63,"10th_percentile":10639.1,"90th_percentile":29476.4},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3446.78,"10th_percentile":3310.57,"90th_percentile":3619.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":3016.23,"10th_percentile":2768.54,"90th_percentile":3448.4,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":17202.51,"10th_percentile":16547.31,"90th_percentile":20195.17},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3346.39,"10th_percentile":3346.39,"90th_percentile":3513.99,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5108.58,"10th_percentile":5108.58,"90th_percentile":5108.58,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":17678.33,"10th_percentile":17242.64,"90th_percentile":18328.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":17836.17,"10th_percentile":17836.17,"90th_percentile":17836.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"105","median_amount":5564.02,"10th_percentile":4743.65,"90th_percentile":5929.56,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":5950.76,"10th_percentile":4743.65,"90th_percentile":9194.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8601.3,"10th_percentile":8601.3,"90th_percentile":8601.3,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":10380.88,"10th_percentile":4980.04,"90th_percentile":10380.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":5734.89,"10th_percentile":5631.89,"90th_percentile":6109.89,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"108","median_amount":5662.96,"10th_percentile":4883.16,"90th_percentile":6103.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":15372.38,"10th_percentile":15372.38,"90th_percentile":15372.38},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5931.93,"10th_percentile":5931.93,"90th_percentile":5931.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":3976.54,"10th_percentile":3976.54,"90th_percentile":3976.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Endovascular Procedures","code_information":[{"code":"5193","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"31","median_amount":11428.6,"10th_percentile":9435.31,"90th_percentile":11794.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":18288.23,"10th_percentile":18288.23,"90th_percentile":18288.23,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20915.86,"10th_percentile":20915.86,"90th_percentile":20915.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":14964.09,"10th_percentile":14964.09,"90th_percentile":18417.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":26396.97,"10th_percentile":26396.97,"90th_percentile":26396.97},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12152.83,"10th_percentile":11777.83,"90th_percentile":12166.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":10829.37,"10th_percentile":9712.83,"90th_percentile":12141.03,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":52482.54,"10th_percentile":52482.54,"90th_percentile":52482.54},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11798.87,"10th_percentile":10524.17,"90th_percentile":18682.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Endovascular Procedures","code_information":[{"code":"5194","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18309.39,"10th_percentile":14939.94,"90th_percentile":18421.29,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":8525.21,"10th_percentile":8525.21,"90th_percentile":8525.21,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":50857.22,"10th_percentile":50857.22,"90th_percentile":50857.22},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18876.04,"10th_percentile":18783.18,"90th_percentile":19224.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18682.39,"10th_percentile":18682.39,"90th_percentile":18682.39,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Electrophysiologic Procedures","code_information":[{"code":"5212","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7098.01,"10th_percentile":7098.01,"90th_percentile":7098.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":7677.98,"10th_percentile":7677.98,"90th_percentile":7677.98,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Electrophysiologic Procedures","code_information":[{"code":"5213","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":22718.05,"10th_percentile":20410.79,"90th_percentile":25256.6,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":39561.75,"10th_percentile":39561.75,"90th_percentile":39561.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":37009.38,"10th_percentile":37009.38,"90th_percentile":37009.38,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":44666.48,"10th_percentile":39761.1,"90th_percentile":44667.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":67614.79,"10th_percentile":48705.6,"90th_percentile":116661.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":26139.42,"10th_percentile":26139.42,"90th_percentile":26514.42,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":72437.0,"10th_percentile":72437.0,"90th_percentile":72437.0},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":25823.52,"10th_percentile":21011.11,"90th_percentile":26331.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":53515.77,"10th_percentile":53515.77,"90th_percentile":53515.77},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":25523.71,"10th_percentile":25523.71,"90th_percentile":25523.71,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Pacemaker and Similar Procedures","code_information":[{"code":"5222","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6885.59,"10th_percentile":6751.53,"90th_percentile":8241.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":11943.33,"10th_percentile":11943.33,"90th_percentile":11943.33,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":8438.22,"10th_percentile":8438.22,"90th_percentile":8438.22},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8493.74,"10th_percentile":8493.74,"90th_percentile":8493.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8792.53,"10th_percentile":8792.53,"90th_percentile":9067.53,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":166.37,"10th_percentile":166.37,"90th_percentile":166.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Pacemaker and Similar Procedures","code_information":[{"code":"5223","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10891.49,"10th_percentile":10518.37,"90th_percentile":10891.51,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":15168.89,"10th_percentile":15168.89,"90th_percentile":15168.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11214.91,"10th_percentile":11214.91,"90th_percentile":20062.13,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":11086.42,"10th_percentile":11086.42,"90th_percentile":19063.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":38022.34,"10th_percentile":38022.34,"90th_percentile":38022.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Pacemaker and Similar Procedures","code_information":[{"code":"5224","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20062.13,"10th_percentile":20062.13,"90th_percentile":20062.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16333.83,"10th_percentile":16333.83,"90th_percentile":16333.83,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 ICD and Similar Procedures","code_information":[{"code":"5231","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":30301.53,"10th_percentile":30301.53,"90th_percentile":30301.53},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":23678.89,"10th_percentile":23678.89,"90th_percentile":23678.89,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19224.42,"10th_percentile":19224.42,"90th_percentile":19224.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ICD and Similar Procedures","code_information":[{"code":"5232","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32978.38,"10th_percentile":32971.52,"90th_percentile":33351.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":51705.3,"10th_percentile":51705.3,"90th_percentile":51705.3,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":57340.68,"10th_percentile":57340.68,"90th_percentile":57340.68,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":242845.3,"10th_percentile":242845.3,"90th_percentile":242845.3},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":973.53,"10th_percentile":973.53,"90th_percentile":973.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"32","median_amount":2288.73,"10th_percentile":1090.72,"90th_percentile":31705.37,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"12","median_amount":3291.67,"10th_percentile":1309.25,"90th_percentile":7686.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":7439.58,"10th_percentile":1807.3,"90th_percentile":176296.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2185.1,"10th_percentile":2185.1,"90th_percentile":2185.1,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"23","median_amount":7392.94,"10th_percentile":2374.87,"90th_percentile":17999.93},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":8675.68,"10th_percentile":2521.74,"90th_percentile":8675.68,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":3271.23,"10th_percentile":3271.23,"90th_percentile":3271.23,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1257.45,"10th_percentile":870.03,"90th_percentile":17004.23,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":2093.54,"10th_percentile":1031.85,"90th_percentile":42399.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":6424.97,"10th_percentile":6424.97,"90th_percentile":6424.97},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2238.1,"10th_percentile":2238.1,"90th_percentile":2238.1,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2420.95,"10th_percentile":1903.69,"90th_percentile":25827.44,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"17","median_amount":6544.98,"10th_percentile":4134.22,"90th_percentile":32455.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"14","median_amount":4112.63,"10th_percentile":1579.23,"90th_percentile":13615.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"73","median_amount":851.73,"10th_percentile":602.66,"90th_percentile":1170.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"29","median_amount":1511.95,"10th_percentile":611.95,"90th_percentile":2138.88,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":449.3,"10th_percentile":449.3,"90th_percentile":449.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"69","median_amount":1558.21,"10th_percentile":1044.42,"90th_percentile":2480.51,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1248.41,"10th_percentile":1248.41,"90th_percentile":1248.41,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"80","median_amount":3746.66,"10th_percentile":1588.19,"90th_percentile":7953.7},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"15","median_amount":4286.72,"10th_percentile":2560.45,"90th_percentile":7332.8,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":829.71,"10th_percentile":679.71,"90th_percentile":1507.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":2031.94,"10th_percentile":2031.94,"90th_percentile":2031.94},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"62","median_amount":892.33,"10th_percentile":562.74,"90th_percentile":1342.95,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"20","median_amount":3977.52,"10th_percentile":2199.44,"90th_percentile":9951.61},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":975.45,"10th_percentile":920.26,"90th_percentile":1579.39,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"13","median_amount":1212.55,"10th_percentile":1093.56,"90th_percentile":1873.72,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"35","median_amount":2761.82,"10th_percentile":1168.0,"90th_percentile":5239.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":3495.73,"10th_percentile":3495.73,"90th_percentile":3495.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"79","median_amount":1707.32,"10th_percentile":1555.67,"90th_percentile":2140.39,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"20","median_amount":2974.16,"10th_percentile":1972.86,"90th_percentile":3079.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3104.81,"10th_percentile":2728.21,"90th_percentile":4003.4,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"49","median_amount":3185.54,"10th_percentile":2010.92,"90th_percentile":3453.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"80","median_amount":5219.57,"10th_percentile":2893.86,"90th_percentile":8366.14},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":5641.6,"10th_percentile":3724.95,"90th_percentile":25762.65,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":1657.86,"10th_percentile":1657.86,"90th_percentile":2949.87,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"62","median_amount":1752.38,"10th_percentile":1589.89,"90th_percentile":2401.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"18","median_amount":5416.61,"10th_percentile":4305.07,"90th_percentile":12989.59},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":1973.65,"10th_percentile":1973.65,"90th_percentile":5289.21,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2736.2,"10th_percentile":2736.2,"90th_percentile":4625.95,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"21","median_amount":5979.45,"10th_percentile":3604.1,"90th_percentile":10087.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Upper GI Procedures","code_information":[{"code":"5303","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3970.44,"10th_percentile":3970.44,"90th_percentile":3970.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":5135.33,"10th_percentile":5135.33,"90th_percentile":6135.33,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2530.25,"10th_percentile":2530.25,"90th_percentile":2530.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6926.99,"10th_percentile":6926.99,"90th_percentile":6926.99,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","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://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":20512.0,"10th_percentile":20512.0,"90th_percentile":20512.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3702.03,"10th_percentile":3702.03,"90th_percentile":3702.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":18298.68,"10th_percentile":18298.68,"90th_percentile":18298.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"22","median_amount":3966.4,"10th_percentile":3274.4,"90th_percentile":6522.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"119","median_amount":948.17,"10th_percentile":948.17,"90th_percentile":1474.15,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"51","median_amount":1470.25,"10th_percentile":1112.74,"90th_percentile":2027.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1375.4,"10th_percentile":1267.78,"90th_percentile":1375.4,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"110","median_amount":1659.96,"10th_percentile":1362.61,"90th_percentile":2537.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1471.28,"10th_percentile":1216.45,"90th_percentile":1562.89,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"260","median_amount":3601.98,"10th_percentile":2468.11,"90th_percentile":6429.94},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"25","median_amount":4052.8,"10th_percentile":3676.8,"90th_percentile":5808.48,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":977.01,"10th_percentile":977.01,"90th_percentile":1352.01,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"105","median_amount":976.06,"10th_percentile":976.06,"90th_percentile":1491.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"41","median_amount":3959.28,"10th_percentile":3592.68,"90th_percentile":5692.96},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":948.55,"10th_percentile":874.33,"90th_percentile":1449.73,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"13","median_amount":1191.91,"10th_percentile":963.0,"90th_percentile":1972.94,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"74","median_amount":4122.4,"10th_percentile":3493.76,"90th_percentile":6539.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"33","median_amount":4512.2,"10th_percentile":3989.6,"90th_percentile":5854.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"235","median_amount":1226.23,"10th_percentile":1226.23,"90th_percentile":2093.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"68","median_amount":1901.43,"10th_percentile":1749.81,"90th_percentile":2852.14,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":1778.76,"10th_percentile":300.0,"90th_percentile":3394.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"141","median_amount":2146.76,"10th_percentile":1288.06,"90th_percentile":2823.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1433.18,"10th_percentile":1433.18,"90th_percentile":1796.57,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"374","median_amount":4300.54,"10th_percentile":3637.96,"90th_percentile":7321.21},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"37","median_amount":4516.8,"10th_percentile":3989.6,"90th_percentile":8157.91,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"56","median_amount":1390.88,"10th_percentile":1263.53,"90th_percentile":2112.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"180","median_amount":1262.3,"10th_percentile":1262.3,"90th_percentile":1893.45,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"70","median_amount":4774.38,"10th_percentile":3897.66,"90th_percentile":8154.9},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"47","median_amount":1714.45,"10th_percentile":1226.73,"90th_percentile":2327.81,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"15","median_amount":1404.99,"10th_percentile":1183.84,"90th_percentile":2677.45,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"98","median_amount":4586.4,"10th_percentile":2573.12,"90th_percentile":6672.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":3263.38,"10th_percentile":3222.54,"90th_percentile":4201.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4993.14,"10th_percentile":1189.79,"90th_percentile":4993.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4187.68,"10th_percentile":4187.68,"90th_percentile":5810.64,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":12598.41,"10th_percentile":12598.41,"90th_percentile":13009.78},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2935.96,"10th_percentile":2935.96,"90th_percentile":2935.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":16214.64,"10th_percentile":16214.64,"90th_percentile":16214.64},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2853.22,"10th_percentile":2853.22,"90th_percentile":2853.22,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5967.37,"10th_percentile":5907.37,"90th_percentile":6090.66,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":14027.51,"10th_percentile":10847.87,"90th_percentile":21906.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Complex GI Procedures","code_information":[{"code":"5331","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5818.5,"10th_percentile":4952.72,"90th_percentile":5845.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":8599.74,"10th_percentile":7706.02,"90th_percentile":9674.74,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10838.42,"10th_percentile":10207.88,"90th_percentile":10896.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":21576.1,"10th_percentile":20416.0,"90th_percentile":28499.54},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":20172.27,"10th_percentile":20172.27,"90th_percentile":20172.27,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6004.18,"10th_percentile":6004.18,"90th_percentile":6004.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5771.27,"10th_percentile":5352.12,"90th_percentile":6372.99,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6388.3,"10th_percentile":6388.3,"90th_percentile":6739.13,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":19762.35,"10th_percentile":19762.35,"90th_percentile":34193.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":5129.97,"10th_percentile":5129.97,"90th_percentile":5129.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3397.81,"10th_percentile":3297.81,"90th_percentile":3677.81,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":4289.49,"10th_percentile":4289.49,"90th_percentile":5129.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6240.55,"10th_percentile":5376.3,"90th_percentile":6779.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":7924.77,"10th_percentile":7924.77,"90th_percentile":7924.77,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"13","median_amount":29917.83,"10th_percentile":13056.32,"90th_percentile":42249.39},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":37445.97,"10th_percentile":37445.97,"90th_percentile":37445.97,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3695.36,"10th_percentile":3337.14,"90th_percentile":4239.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":30656.86,"10th_percentile":30656.86,"90th_percentile":30656.86},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3671.68,"10th_percentile":3671.68,"90th_percentile":3771.68,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3735.86,"10th_percentile":3735.86,"90th_percentile":6150.44,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":50316.49,"10th_percentile":50316.49,"90th_percentile":50316.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5342","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6123.77,"10th_percentile":6123.77,"90th_percentile":6123.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":10062.46,"10th_percentile":10062.46,"90th_percentile":10062.46,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11360.84,"10th_percentile":11360.84,"90th_percentile":20080.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6580.11,"10th_percentile":6580.11,"90th_percentile":6683.35,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":25.0,"10th_percentile":25.0,"90th_percentile":25.0},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6610.91,"10th_percentile":6610.91,"90th_percentile":6610.91,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":7122.3,"10th_percentile":7122.3,"90th_percentile":7122.3,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":52037.72,"10th_percentile":52037.72,"90th_percentile":52037.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":35486.4,"10th_percentile":23347.49,"90th_percentile":63743.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":5702.17,"10th_percentile":4854.17,"90th_percentile":7305.62,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"25","median_amount":8989.22,"10th_percentile":7825.51,"90th_percentile":10689.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8060.99,"10th_percentile":8060.99,"90th_percentile":8060.99,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"53","median_amount":10622.75,"10th_percentile":8929.73,"90th_percentile":14742.78,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6567.0,"10th_percentile":4221.06,"90th_percentile":8702.41,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"106","median_amount":28030.71,"10th_percentile":17179.49,"90th_percentile":53625.71},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":7590.42,"10th_percentile":7590.42,"90th_percentile":7590.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"13","median_amount":27338.65,"10th_percentile":21466.36,"90th_percentile":36463.41,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6781.56,"10th_percentile":5877.24,"90th_percentile":7156.56,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":35140.7,"10th_percentile":35140.7,"90th_percentile":35140.7},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":5940.18,"10th_percentile":5486.46,"90th_percentile":6500.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"19","median_amount":26969.61,"10th_percentile":21407.88,"90th_percentile":44973.91},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6070.14,"10th_percentile":6070.14,"90th_percentile":6070.14,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"19","median_amount":6681.06,"10th_percentile":2613.53,"90th_percentile":7787.95,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"29","median_amount":27903.12,"10th_percentile":18867.16,"90th_percentile":49626.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":38138.12,"10th_percentile":37405.88,"90th_percentile":44598.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10455.24,"10th_percentile":8687.11,"90th_percentile":10648.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":15363.47,"10th_percentile":14786.12,"90th_percentile":16789.55,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16165.39,"10th_percentile":16165.39,"90th_percentile":16165.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":17368.14,"10th_percentile":16406.38,"90th_percentile":18955.93,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"50","median_amount":34050.12,"10th_percentile":22947.37,"90th_percentile":58108.05},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":40834.91,"10th_percentile":30336.46,"90th_percentile":55788.31,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10969.01,"10th_percentile":10969.01,"90th_percentile":10969.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10813.09,"10th_percentile":8916.87,"90th_percentile":10970.09,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":40053.82,"10th_percentile":32491.32,"90th_percentile":60750.45},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10831.96,"10th_percentile":10831.96,"90th_percentile":10833.78,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":7781.9,"10th_percentile":5575.41,"90th_percentile":7999.94,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"12","median_amount":44748.38,"10th_percentile":31442.61,"90th_percentile":56728.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Urology and Related Services","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":667.09,"10th_percentile":636.61,"90th_percentile":693.34,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1149.02,"10th_percentile":1149.02,"90th_percentile":1149.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":700.01,"10th_percentile":579.2,"90th_percentile":832.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":923.78,"10th_percentile":923.78,"90th_percentile":923.78,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":20525.44,"10th_percentile":20525.44,"90th_percentile":20525.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":661.9,"10th_percentile":328.63,"90th_percentile":2779.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":1076.4,"10th_percentile":996.4,"90th_percentile":8282.65,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":911.45,"10th_percentile":911.45,"90th_percentile":911.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5837.65,"10th_percentile":5837.65,"90th_percentile":5837.65,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":8526.45,"10th_percentile":1865.86,"90th_percentile":11862.45},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":483.83,"10th_percentile":483.83,"90th_percentile":483.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":571.74,"10th_percentile":273.58,"90th_percentile":6102.67,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":11273.1,"10th_percentile":5236.32,"90th_percentile":15157.15},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":694.44,"10th_percentile":694.44,"90th_percentile":694.44,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":66.67,"10th_percentile":66.67,"90th_percentile":66.67,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":10726.4,"10th_percentile":10726.4,"90th_percentile":10726.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":8132.88,"10th_percentile":8132.88,"90th_percentile":8170.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":1953.22,"10th_percentile":1703.22,"90th_percentile":2136.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":3300.5,"10th_percentile":3017.18,"90th_percentile":5720.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3729.76,"10th_percentile":2712.07,"90th_percentile":3729.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":401.38,"10th_percentile":401.38,"90th_percentile":401.38,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"19","median_amount":11227.09,"10th_percentile":5867.54,"90th_percentile":14213.56},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":351.6,"10th_percentile":329.41,"90th_percentile":2366.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":9280.88,"10th_percentile":9280.88,"90th_percentile":9536.13,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1974.84,"10th_percentile":1890.23,"90th_percentile":3810.05,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":2012.42,"10th_percentile":1752.09,"90th_percentile":2260.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"11","median_amount":10695.91,"10th_percentile":8293.22,"90th_percentile":15998.11},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2131.29,"10th_percentile":1948.5,"90th_percentile":2131.29,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"12","median_amount":374.25,"10th_percentile":351.87,"90th_percentile":2530.15,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":13838.38,"10th_percentile":8809.83,"90th_percentile":13899.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":10633.65,"10th_percentile":10633.65,"90th_percentile":10633.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":3221.38,"10th_percentile":380.0,"90th_percentile":3348.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":5561.94,"10th_percentile":4761.94,"90th_percentile":5562.89,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3939.64,"10th_percentile":3939.64,"90th_percentile":3939.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":6049.8,"10th_percentile":4782.54,"90th_percentile":27878.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3437.52,"10th_percentile":3437.52,"90th_percentile":3437.52,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"23","median_amount":15162.13,"10th_percentile":6861.44,"90th_percentile":24345.96},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":27254.4,"10th_percentile":27254.4,"90th_percentile":27254.4,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3603.7,"10th_percentile":3567.23,"90th_percentile":3696.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":3440.61,"10th_percentile":3029.91,"90th_percentile":3698.39,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":17701.82,"10th_percentile":13277.94,"90th_percentile":31753.86},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":3588.35,"10th_percentile":3588.35,"90th_percentile":3588.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":25044.39,"10th_percentile":25044.39,"90th_percentile":37301.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":5168.53,"10th_percentile":4414.48,"90th_percentile":10290.22,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":8218.04,"10th_percentile":6297.01,"90th_percentile":20083.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8607.95,"10th_percentile":6000.79,"90th_percentile":9255.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5599.94,"10th_percentile":5599.94,"90th_percentile":5611.94,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":5410.88,"10th_percentile":5001.44,"90th_percentile":8404.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":17148.14,"10th_percentile":17148.14,"90th_percentile":50948.38},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5394.06,"10th_percentile":5186.17,"90th_percentile":10157.68,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 6 Urology and Related Services","code_information":[{"code":"5376","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9624.6,"10th_percentile":9624.6,"90th_percentile":9624.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":10676.94,"10th_percentile":10676.94,"90th_percentile":10676.94},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":38108.9,"10th_percentile":38108.9,"90th_percentile":38108.9,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10284.48,"10th_percentile":10284.48,"90th_percentile":10284.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9908.85,"10th_percentile":9908.85,"90th_percentile":9908.85,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Dialysis","code_information":[{"code":"5401","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":14024.83,"10th_percentile":14024.83,"90th_percentile":14024.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":2681.95,"10th_percentile":1396.55,"90th_percentile":3281.49,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4820.78,"10th_percentile":4820.78,"90th_percentile":4820.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":164.25,"10th_percentile":164.25,"90th_percentile":164.25,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":136.75,"10th_percentile":136.75,"90th_percentile":136.75,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":12135.16,"10th_percentile":12135.16,"90th_percentile":12135.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":16314.4,"10th_percentile":16314.4,"90th_percentile":16314.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":288.11,"10th_percentile":288.11,"90th_percentile":288.11,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1954.43,"10th_percentile":1954.43,"90th_percentile":1954.43,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Gynecologic Procedures","code_information":[{"code":"5412","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1358.93,"10th_percentile":1358.93,"90th_percentile":3565.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":554.05,"10th_percentile":554.05,"90th_percentile":554.05,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":14291.82,"10th_percentile":13585.6,"90th_percentile":16278.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2645.35,"10th_percentile":2645.35,"90th_percentile":2995.12,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"13","median_amount":4133.63,"10th_percentile":3476.82,"90th_percentile":5128.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":5233.9,"10th_percentile":4452.67,"90th_percentile":12997.22,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3346.41,"10th_percentile":2932.0,"90th_percentile":4561.4,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"30","median_amount":13512.01,"10th_percentile":10394.0,"90th_percentile":26019.47},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":11868.21,"10th_percentile":11588.4,"90th_percentile":13818.99,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3087.09,"10th_percentile":3062.96,"90th_percentile":3388.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":13228.28,"10th_percentile":11129.54,"90th_percentile":16898.47},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3308.02,"10th_percentile":3308.02,"90th_percentile":3308.02,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"15","median_amount":3955.65,"10th_percentile":3264.55,"90th_percentile":5501.5,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":18669.34,"10th_percentile":12664.43,"90th_percentile":23663.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":17797.44,"10th_percentile":17797.44,"90th_percentile":17797.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5048.7,"10th_percentile":4926.98,"90th_percentile":5141.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":6402.46,"10th_percentile":5779.23,"90th_percentile":7963.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7447.11,"10th_percentile":7447.11,"90th_percentile":7447.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8412.47,"10th_percentile":6928.53,"90th_percentile":11575.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6449.5,"10th_percentile":6449.5,"90th_percentile":6449.5,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"21","median_amount":22904.37,"10th_percentile":14635.52,"90th_percentile":59587.08},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":23751.55,"10th_percentile":23751.55,"90th_percentile":31499.6,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4925.02,"10th_percentile":4925.02,"90th_percentile":4925.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4843.89,"10th_percentile":4843.89,"90th_percentile":4843.89,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":20045.22,"10th_percentile":18586.67,"90th_percentile":23362.49},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5135.94,"10th_percentile":5135.94,"90th_percentile":5137.44,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":6297.04,"10th_percentile":5416.02,"90th_percentile":22170.15,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":23500.78,"10th_percentile":16900.95,"90th_percentile":38719.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 6 Gynecologic Procedures","code_information":[{"code":"5416","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6152.46,"10th_percentile":6152.46,"90th_percentile":7700.24,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9101.72,"10th_percentile":9101.72,"90th_percentile":9101.72,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7925.74,"10th_percentile":7925.74,"90th_percentile":7925.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7693.65,"10th_percentile":7693.65,"90th_percentile":7693.65,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":7791.31,"10th_percentile":7791.31,"90th_percentile":7791.31,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":5756.06,"10th_percentile":5756.06,"90th_percentile":5756.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":1807.32,"10th_percentile":1577.83,"90th_percentile":3574.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":2410.11,"10th_percentile":634.4,"90th_percentile":3300.46,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":3339.74,"10th_percentile":1139.98,"90th_percentile":10024.54,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1792.64,"10th_percentile":1792.64,"90th_percentile":1792.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":1908.12,"10th_percentile":1649.6,"90th_percentile":5722.85,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":7129.31,"10th_percentile":6970.59,"90th_percentile":11224.0},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2274.51,"10th_percentile":1536.92,"90th_percentile":2722.55,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1405.16,"10th_percentile":1405.16,"90th_percentile":1405.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":12860.88,"10th_percentile":7331.35,"90th_percentile":26017.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Nerve Procedures","code_information":[{"code":"5432","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":10327.45,"10th_percentile":10327.45,"90th_percentile":10327.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":734.48,"10th_percentile":333.23,"90th_percentile":1475.24,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":500.99,"10th_percentile":445.32,"90th_percentile":2116.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":794.34,"10th_percentile":96.32,"90th_percentile":1436.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":678.27,"10th_percentile":678.27,"90th_percentile":678.27,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"23","median_amount":3030.28,"10th_percentile":1515.3,"90th_percentile":4592.55},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":1394.0,"10th_percentile":1394.0,"90th_percentile":1394.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1675.81,"10th_percentile":357.03,"90th_percentile":1675.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"38","median_amount":454.05,"10th_percentile":249.12,"90th_percentile":950.61,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":3887.5,"10th_percentile":1967.75,"90th_percentile":4795.2},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1227.8,"10th_percentile":876.15,"90th_percentile":1660.35,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":799.76,"10th_percentile":799.76,"90th_percentile":803.11,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":2509.6,"10th_percentile":2509.6,"90th_percentile":2509.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":703.18,"10th_percentile":703.18,"90th_percentile":3431.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"85","median_amount":949.61,"10th_percentile":566.27,"90th_percentile":1549.88,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"30","median_amount":1221.44,"10th_percentile":770.68,"90th_percentile":2158.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1086.43,"10th_percentile":1086.43,"90th_percentile":2090.49,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"59","median_amount":1260.89,"10th_percentile":847.45,"90th_percentile":2525.34,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1684.95,"10th_percentile":1684.95,"90th_percentile":1684.95,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"52","median_amount":3177.91,"10th_percentile":313.48,"90th_percentile":6476.42},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":4280.68,"10th_percentile":3781.84,"90th_percentile":4999.82,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":715.62,"10th_percentile":398.12,"90th_percentile":1321.14,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"71","median_amount":738.3,"10th_percentile":110.56,"90th_percentile":1437.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"33","median_amount":4229.52,"10th_percentile":2559.87,"90th_percentile":5653.6},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":1416.14,"10th_percentile":883.48,"90th_percentile":3875.27,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1248.48,"10th_percentile":340.94,"90th_percentile":1592.66,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"15","median_amount":5552.66,"10th_percentile":1542.58,"90th_percentile":6136.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":1435.72,"10th_percentile":1435.72,"90th_percentile":1435.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":1496.37,"10th_percentile":1019.92,"90th_percentile":3007.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"18","median_amount":2187.78,"10th_percentile":1641.58,"90th_percentile":3988.17,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2438.1,"10th_percentile":2438.1,"90th_percentile":2438.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":2477.06,"10th_percentile":1620.97,"90th_percentile":5115.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"47","median_amount":3920.87,"10th_percentile":2533.55,"90th_percentile":5339.35},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":965.33,"10th_percentile":965.33,"90th_percentile":965.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":4583.04,"10th_percentile":3757.9,"90th_percentile":7493.8,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1056.08,"10th_percentile":1056.08,"90th_percentile":1056.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":1671.54,"10th_percentile":988.7,"90th_percentile":2454.3,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"12","median_amount":5478.89,"10th_percentile":5162.1,"90th_percentile":8214.3},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4244.52,"10th_percentile":4244.52,"90th_percentile":4244.52,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1098.65,"10th_percentile":1098.65,"90th_percentile":1308.82,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":7515.96,"10th_percentile":5130.55,"90th_percentile":11503.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Neurostimulator and Related Procedures","code_information":[{"code":"5461","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5987.8,"10th_percentile":5987.8,"90th_percentile":5987.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":18449.6,"10th_percentile":18449.6,"90th_percentile":18449.6,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11952.23,"10th_percentile":11952.23,"90th_percentile":11952.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":27775.29,"10th_percentile":2041.31,"90th_percentile":35694.31},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Neurostimulator and Related Procedures","code_information":[{"code":"5464","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":125515.2,"10th_percentile":125515.2,"90th_percentile":125515.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21929.69,"10th_percentile":17841.66,"90th_percentile":21936.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":39044.25,"10th_percentile":39044.25,"90th_percentile":39044.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":89057.1,"10th_percentile":88990.9,"90th_percentile":103105.0},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Neurostimulator and Related Procedures","code_information":[{"code":"5465","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":31699.87,"10th_percentile":31326.87,"90th_percentile":31701.51,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":129131.61,"10th_percentile":129131.61,"90th_percentile":130876.0},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4864.22,"10th_percentile":4864.22,"90th_percentile":4864.22,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":1108.9,"10th_percentile":1108.9,"90th_percentile":1108.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Implantation of Drug Infusion Device","code_information":[{"code":"5471","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15426.49,"10th_percentile":15426.49,"90th_percentile":15426.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":3571.61,"10th_percentile":2938.98,"90th_percentile":4152.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2404.98,"10th_percentile":2169.09,"90th_percentile":2444.09,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":2000.72,"10th_percentile":1953.38,"90th_percentile":2610.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":2372.9,"10th_percentile":2372.9,"90th_percentile":2372.9,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Intraocular Procedures","code_information":[{"code":"5492","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":2595.69,"10th_percentile":2595.69,"90th_percentile":2595.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3811.37,"10th_percentile":3347.01,"90th_percentile":3918.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":6487.43,"10th_percentile":6487.43,"90th_percentile":6738.83,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6774.18,"10th_percentile":4850.97,"90th_percentile":7444.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3936.0,"10th_percentile":3936.0,"90th_percentile":3936.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3746.06,"10th_percentile":3445.44,"90th_percentile":4010.56,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":14096.6,"10th_percentile":14096.6,"90th_percentile":14096.6},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4185.43,"10th_percentile":4185.43,"90th_percentile":4185.43,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3698.11,"10th_percentile":3698.11,"90th_percentile":3698.11,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Intraocular Procedures","code_information":[{"code":"5493","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":11974.83,"10th_percentile":11974.83,"90th_percentile":11974.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5187.04,"10th_percentile":4426.33,"90th_percentile":5381.52,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9394.4,"10th_percentile":8547.94,"90th_percentile":9394.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"45","median_amount":191.36,"10th_percentile":94.64,"90th_percentile":820.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"218","median_amount":86.9,"10th_percentile":71.97,"90th_percentile":404.79,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"125","median_amount":134.74,"10th_percentile":101.06,"90th_percentile":500.95,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"72","median_amount":95.44,"10th_percentile":39.01,"90th_percentile":802.55,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"340","median_amount":234.18,"10th_percentile":105.89,"90th_percentile":1352.45},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"1 through 10","median_amount":89.78,"10th_percentile":89.78,"90th_percentile":89.78},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"32","median_amount":283.68,"10th_percentile":135.2,"90th_percentile":1538.18,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"184","median_amount":91.28,"10th_percentile":33.53,"90th_percentile":324.92,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"79","median_amount":175.0,"10th_percentile":80.0,"90th_percentile":1781.92},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"1 through 10","median_amount":125.0,"10th_percentile":100.0,"90th_percentile":509.5,"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":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"84","median_amount":91.61,"10th_percentile":86.93,"90th_percentile":225.69,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"94","median_amount":239.2,"10th_percentile":108.16,"90th_percentile":1309.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"106","median_amount":302.4,"10th_percentile":191.36,"90th_percentile":964.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"921","median_amount":110.58,"10th_percentile":85.52,"90th_percentile":210.28,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"253","median_amount":163.01,"10th_percentile":120.04,"90th_percentile":362.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":160.43,"10th_percentile":120.32,"90th_percentile":269.69,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"443","median_amount":193.62,"10th_percentile":138.05,"90th_percentile":348.83,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"75","median_amount":81.92,"10th_percentile":63.12,"90th_percentile":398.31,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"878","median_amount":296.05,"10th_percentile":145.21,"90th_percentile":970.39},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"64","median_amount":79.01,"10th_percentile":39.09,"90th_percentile":351.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"96","median_amount":302.4,"10th_percentile":206.4,"90th_percentile":988.8,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"187","median_amount":113.95,"10th_percentile":91.16,"90th_percentile":216.7,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"598","median_amount":113.85,"10th_percentile":66.4,"90th_percentile":216.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"145","median_amount":201.24,"10th_percentile":105.0,"90th_percentile":953.94},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"65","median_amount":150.0,"10th_percentile":75.0,"90th_percentile":459.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"120","median_amount":110.64,"10th_percentile":105.17,"90th_percentile":219.9,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"237","median_amount":302.4,"10th_percentile":100.0,"90th_percentile":884.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"29","median_amount":984.0,"10th_percentile":366.13,"90th_percentile":1574.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"268","median_amount":232.96,"10th_percentile":144.09,"90th_percentile":321.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"92","median_amount":360.26,"10th_percentile":272.51,"90th_percentile":389.81,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":273.49,"10th_percentile":273.49,"90th_percentile":611.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"211","median_amount":399.29,"10th_percentile":276.83,"90th_percentile":440.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"34","median_amount":462.95,"10th_percentile":448.19,"90th_percentile":708.22,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"297","median_amount":850.67,"10th_percentile":213.34,"90th_percentile":1292.28},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"1 through 10","median_amount":188.62,"10th_percentile":188.62,"90th_percentile":188.62},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"24","median_amount":984.0,"10th_percentile":335.52,"90th_percentile":1414.4,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"81","median_amount":240.69,"10th_percentile":59.03,"90th_percentile":378.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":251.49,"10th_percentile":234.41,"90th_percentile":453.74,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"90","median_amount":836.4,"10th_percentile":313.86,"90th_percentile":1476.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"21","median_amount":2600.3,"10th_percentile":100.0,"90th_percentile":3409.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"199","median_amount":521.09,"10th_percentile":456.19,"90th_percentile":752.87,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"190","median_amount":2684.23,"10th_percentile":1336.95,"90th_percentile":3652.78},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"21","median_amount":2320.0,"10th_percentile":840.69,"90th_percentile":3796.0,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"45","median_amount":3029.2,"10th_percentile":2267.44,"90th_percentile":3486.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"24","median_amount":1005.6,"10th_percentile":383.0,"90th_percentile":1791.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"267","median_amount":180.92,"10th_percentile":140.56,"90th_percentile":452.51,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":330.0,"10th_percentile":242.13,"90th_percentile":656.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"139","median_amount":324.12,"10th_percentile":243.09,"90th_percentile":976.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"18","median_amount":267.05,"10th_percentile":169.73,"90th_percentile":2080.9,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"303","median_amount":631.88,"10th_percentile":355.26,"90th_percentile":1308.33},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"1 through 10","median_amount":50.0,"10th_percentile":50.0,"90th_percentile":50.0},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"26","median_amount":602.4,"10th_percentile":191.88,"90th_percentile":1350.4,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"58","median_amount":187.72,"10th_percentile":70.56,"90th_percentile":466.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"176","median_amount":178.73,"10th_percentile":144.09,"90th_percentile":464.72,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"33","median_amount":766.74,"10th_percentile":415.73,"90th_percentile":1599.04},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"31","median_amount":536.18,"10th_percentile":119.14,"90th_percentile":1081.12,"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":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"48","median_amount":185.21,"10th_percentile":175.77,"90th_percentile":452.7,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"38","median_amount":217.02,"10th_percentile":166.12,"90th_percentile":436.59,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"81","median_amount":1052.4,"10th_percentile":362.88,"90th_percentile":1876.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"35","median_amount":1354.24,"10th_percentile":655.98,"90th_percentile":1754.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"309","median_amount":297.13,"10th_percentile":77.41,"90th_percentile":704.71,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"73","median_amount":566.71,"10th_percentile":403.14,"90th_percentile":678.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":530.15,"10th_percentile":404.08,"90th_percentile":623.95,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"164","median_amount":650.25,"10th_percentile":487.69,"90th_percentile":1167.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"18","median_amount":776.03,"10th_percentile":348.66,"90th_percentile":2532.89,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"348","median_amount":1067.5,"10th_percentile":256.89,"90th_percentile":1789.62},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"29","median_amount":1127.16,"10th_percentile":338.85,"90th_percentile":1668.8,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"71","median_amount":294.19,"10th_percentile":182.71,"90th_percentile":537.68,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":1501.1,"10th_percentile":1501.1,"90th_percentile":1501.1},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"233","median_amount":298.09,"10th_percentile":63.85,"90th_percentile":605.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"35","median_amount":1091.34,"10th_percentile":660.0,"90th_percentile":6776.58},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"40","median_amount":683.4,"10th_percentile":360.0,"90th_percentile":1320.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"52","median_amount":371.56,"10th_percentile":371.56,"90th_percentile":371.56,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"84","median_amount":1318.8,"10th_percentile":461.72,"90th_percentile":2202.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":3032.25,"10th_percentile":3032.25,"90th_percentile":3032.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1198.61,"10th_percentile":876.31,"90th_percentile":1256.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":1750.12,"10th_percentile":1750.12,"90th_percentile":1750.12,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1053.46,"10th_percentile":1053.46,"90th_percentile":1053.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1481.94,"10th_percentile":1481.94,"90th_percentile":1578.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1032.45,"10th_percentile":1032.45,"90th_percentile":1032.45,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":3264.4,"10th_percentile":821.7,"90th_percentile":5726.76},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1592.63,"10th_percentile":1592.63,"90th_percentile":1592.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":6113.2,"10th_percentile":6113.2,"90th_percentile":6113.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":3060.72,"10th_percentile":1501.38,"90th_percentile":3625.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":334.32,"10th_percentile":123.89,"90th_percentile":442.89,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"14","median_amount":611.57,"10th_percentile":453.59,"90th_percentile":1267.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":606.2,"10th_percentile":606.2,"90th_percentile":606.2,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":548.71,"10th_percentile":476.46,"90th_percentile":818.99,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":495.14,"10th_percentile":390.23,"90th_percentile":1446.71,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"49","median_amount":1238.42,"10th_percentile":590.37,"90th_percentile":1889.86},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":1117.6,"10th_percentile":694.08,"90th_percentile":2011.68,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":336.31,"10th_percentile":230.6,"90th_percentile":731.6,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"32","median_amount":289.43,"10th_percentile":111.69,"90th_percentile":436.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":1193.6,"10th_percentile":134.96,"90th_percentile":1518.3},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":418.07,"10th_percentile":394.56,"90th_percentile":418.07,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":428.15,"10th_percentile":345.51,"90th_percentile":938.51,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"13","median_amount":1551.4,"10th_percentile":1219.2,"90th_percentile":2564.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":1497.42,"10th_percentile":1360.0,"90th_percentile":3303.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":465.81,"10th_percentile":265.81,"90th_percentile":1918.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":651.04,"10th_percentile":651.04,"90th_percentile":868.05,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":609.03,"10th_percentile":609.03,"90th_percentile":609.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":931.05,"10th_percentile":678.65,"90th_percentile":1202.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":381.91,"10th_percentile":381.91,"90th_percentile":381.91,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"36","median_amount":1238.91,"10th_percentile":670.77,"90th_percentile":1700.33},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":1355.2,"10th_percentile":1181.06,"90th_percentile":1860.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":679.73,"10th_percentile":679.73,"90th_percentile":679.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":461.01,"10th_percentile":257.77,"90th_percentile":674.92,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":1357.84,"10th_percentile":1233.84,"90th_percentile":3505.32},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":560.02,"10th_percentile":560.02,"90th_percentile":560.02,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":384.51,"10th_percentile":378.32,"90th_percentile":419.02,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":1546.82,"10th_percentile":133.6,"90th_percentile":2907.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"11","median_amount":6792.88,"10th_percentile":1306.2,"90th_percentile":12260.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"102","median_amount":1360.23,"10th_percentile":1063.69,"90th_percentile":2415.66,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"20","median_amount":2105.27,"10th_percentile":1255.27,"90th_percentile":4541.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2746.69,"10th_percentile":2746.69,"90th_percentile":2746.69,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"34","median_amount":2250.17,"10th_percentile":1772.59,"90th_percentile":3375.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"107","median_amount":5412.3,"10th_percentile":2825.8,"90th_percentile":9538.62},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"12","median_amount":5431.15,"10th_percentile":1931.3,"90th_percentile":7112.8,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":1359.14,"10th_percentile":1198.99,"90th_percentile":1986.56,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"102","median_amount":1389.59,"10th_percentile":1079.13,"90th_percentile":1992.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"15","median_amount":6550.48,"10th_percentile":4942.74,"90th_percentile":8286.57},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":1358.24,"10th_percentile":1358.24,"90th_percentile":2180.23,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":4295.51,"10th_percentile":4295.51,"90th_percentile":4295.51,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"34","median_amount":6691.2,"10th_percentile":4399.82,"90th_percentile":15875.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Nuclear Medicine and Related Services","code_information":[{"code":"5594","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":7299.2,"10th_percentile":6547.2,"90th_percentile":20174.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"103","median_amount":1498.16,"10th_percentile":1213.53,"90th_percentile":4475.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"13","median_amount":2319.78,"10th_percentile":1502.17,"90th_percentile":2352.17,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2200.42,"10th_percentile":2052.23,"90th_percentile":2739.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"49","median_amount":2655.68,"10th_percentile":1991.76,"90th_percentile":5626.93,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1836.23,"10th_percentile":1836.23,"90th_percentile":1836.23,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"98","median_amount":6144.74,"10th_percentile":4765.27,"90th_percentile":18077.55},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"1 through 10","median_amount":2682.95,"10th_percentile":2682.95,"90th_percentile":2682.95},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":6098.82,"10th_percentile":4178.34,"90th_percentile":7944.8,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":1738.06,"10th_percentile":1363.06,"90th_percentile":7634.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"116","median_amount":1561.54,"10th_percentile":1243.04,"90th_percentile":5418.71,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"11","median_amount":7746.18,"10th_percentile":6313.59,"90th_percentile":17050.04},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":1517.53,"10th_percentile":1517.53,"90th_percentile":7742.01,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2211.84,"10th_percentile":2014.36,"90th_percentile":4139.12,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"25","median_amount":7299.2,"10th_percentile":6024.4,"90th_percentile":16277.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5611","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":251.96,"10th_percentile":251.96,"90th_percentile":251.96,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":1344.34,"10th_percentile":1344.34,"90th_percentile":1344.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12194.43,"10th_percentile":12194.43,"90th_percentile":12194.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2973.58,"10th_percentile":2973.58,"90th_percentile":2973.58,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":421.77,"10th_percentile":421.77,"90th_percentile":421.77,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5612","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":593.59,"10th_percentile":304.57,"90th_percentile":1265.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":2160.61,"10th_percentile":761.91,"90th_percentile":2160.61,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1135.79,"10th_percentile":1135.79,"90th_percentile":4463.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":9766.73,"10th_percentile":9766.73,"90th_percentile":9766.73,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":2243.87,"10th_percentile":2106.03,"90th_percentile":6669.1},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":160.0,"10th_percentile":160.0,"90th_percentile":160.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1239.35,"10th_percentile":410.88,"90th_percentile":1382.46,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":12100.34,"10th_percentile":12100.34,"90th_percentile":12100.34},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1396.07,"10th_percentile":1396.07,"90th_percentile":1396.07,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":12148.84,"10th_percentile":2284.81,"90th_percentile":25355.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5613","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":6699.24,"10th_percentile":6699.24,"90th_percentile":6699.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":3788.21,"10th_percentile":2392.54,"90th_percentile":5757.97,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":9403.45,"10th_percentile":6269.16,"90th_percentile":10026.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":22479.91,"10th_percentile":22479.91,"90th_percentile":22479.91,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":55046.95,"10th_percentile":5680.14,"90th_percentile":55046.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"20","median_amount":23698.23,"10th_percentile":9405.0,"90th_percentile":241895.37},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":27995.83,"10th_percentile":27995.83,"90th_percentile":27995.83,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3392.41,"10th_percentile":601.46,"90th_percentile":3752.49,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":4106.66,"10th_percentile":2996.25,"90th_percentile":29066.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":29997.99,"10th_percentile":29997.99,"90th_percentile":29997.99},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5297.41,"10th_percentile":3027.07,"90th_percentile":19924.48,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":3613.77,"10th_percentile":3065.09,"90th_percentile":10205.55,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":50323.66,"10th_percentile":11564.17,"90th_percentile":50323.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Radiation Therapy","code_information":[{"code":"5621","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1181.4,"10th_percentile":1181.4,"90th_percentile":1181.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Radiation Therapy","code_information":[{"code":"5622","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":29825.58,"10th_percentile":6174.16,"90th_percentile":29825.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":8048.95,"10th_percentile":1897.06,"90th_percentile":13926.45,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":4424.46,"10th_percentile":3177.08,"90th_percentile":11002.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":16563.23,"10th_percentile":1193.83,"90th_percentile":25453.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":14991.32,"10th_percentile":14991.32,"90th_percentile":14991.32,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"24","median_amount":31361.0,"10th_percentile":15533.22,"90th_percentile":101422.32},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":39512.1,"10th_percentile":24603.1,"90th_percentile":39512.1,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10603.99,"10th_percentile":1916.39,"90th_percentile":15886.49,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":6968.32,"10th_percentile":2538.71,"90th_percentile":18390.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":273225.38,"10th_percentile":273225.38,"90th_percentile":273225.38},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":100328.19,"10th_percentile":21223.84,"90th_percentile":189116.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Radiation Therapy","code_information":[{"code":"5623","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":82650.21,"10th_percentile":74305.51,"90th_percentile":240323.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"57","median_amount":12148.42,"10th_percentile":5563.61,"90th_percentile":22362.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":38392.15,"10th_percentile":27860.9,"90th_percentile":128740.52,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":36068.73,"10th_percentile":33784.99,"90th_percentile":36068.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":35483.62,"10th_percentile":4820.78,"90th_percentile":48974.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":61435.54,"10th_percentile":61435.54,"90th_percentile":61435.54,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":17456.32,"10th_percentile":3777.63,"90th_percentile":20778.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"49","median_amount":16698.62,"10th_percentile":6127.24,"90th_percentile":22584.16,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":44135.65,"10th_percentile":1631.38,"90th_percentile":48289.87},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":14099.97,"10th_percentile":7214.18,"90th_percentile":20453.93,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":33101.81,"10th_percentile":9146.66,"90th_percentile":33101.81,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"24","median_amount":37064.63,"10th_percentile":9909.2,"90th_percentile":67807.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Radiation Therapy","code_information":[{"code":"5624","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":31079.92,"10th_percentile":31079.92,"90th_percentile":31079.92,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9797.43,"10th_percentile":295.48,"90th_percentile":10053.36,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32202.14,"10th_percentile":32202.14,"90th_percentile":32202.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":812.85,"10th_percentile":812.85,"90th_percentile":812.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":36.15,"10th_percentile":36.15,"90th_percentile":36.15,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":80.36,"10th_percentile":80.36,"90th_percentile":80.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":110.34,"10th_percentile":72.96,"90th_percentile":156.55,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":247.2,"10th_percentile":103.2,"90th_percentile":366.72,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":56.98,"10th_percentile":56.98,"90th_percentile":64.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":341.64,"10th_percentile":259.23,"90th_percentile":9650.02},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":80.39,"10th_percentile":55.59,"90th_percentile":1840.09,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":73.72,"10th_percentile":73.72,"90th_percentile":73.72,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":5553.6,"10th_percentile":5553.6,"90th_percentile":5553.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":186.06,"10th_percentile":156.77,"90th_percentile":708.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":19074.4,"10th_percentile":19074.4,"90th_percentile":19074.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":183.64,"10th_percentile":183.64,"90th_percentile":183.64,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":171.29,"10th_percentile":171.29,"90th_percentile":171.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":842.4,"10th_percentile":842.4,"90th_percentile":842.4},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":3318.77,"10th_percentile":3050.9,"90th_percentile":3318.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":678.56,"10th_percentile":344.6,"90th_percentile":2758.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":1013.76,"10th_percentile":1013.76,"90th_percentile":1028.47,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":639.96,"10th_percentile":639.96,"90th_percentile":2147.05,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":110.98,"10th_percentile":110.98,"90th_percentile":110.98,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"19","median_amount":2430.89,"10th_percentile":955.97,"90th_percentile":6050.05},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":2018.86,"10th_percentile":2018.86,"90th_percentile":2018.86},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1026.12,"10th_percentile":686.63,"90th_percentile":1237.24,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":432.93,"10th_percentile":165.94,"90th_percentile":772.66,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":3128.29,"10th_percentile":3128.29,"90th_percentile":3128.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":22962.83,"10th_percentile":22962.83,"90th_percentile":22962.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":2520.49,"10th_percentile":2213.61,"90th_percentile":2971.49,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":4536.82,"10th_percentile":858.44,"90th_percentile":5537.1,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":5178.89,"10th_percentile":2702.62,"90th_percentile":7433.71,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"28","median_amount":9422.95,"10th_percentile":1541.34,"90th_percentile":16571.49},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3013.88,"10th_percentile":3013.88,"90th_percentile":3013.88,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"23","median_amount":3041.67,"10th_percentile":383.82,"90th_percentile":5287.25,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":14433.56,"10th_percentile":3434.4,"90th_percentile":23231.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"36","median_amount":1652.61,"10th_percentile":341.12,"90th_percentile":6308.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"673","median_amount":340.04,"10th_percentile":151.56,"90th_percentile":1746.0,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":278.29,"10th_percentile":226.98,"90th_percentile":2848.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"204","median_amount":345.21,"10th_percentile":175.98,"90th_percentile":1370.68,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"15","median_amount":453.03,"10th_percentile":234.11,"90th_percentile":1129.93,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"363","median_amount":1110.04,"10th_percentile":128.03,"90th_percentile":23898.61},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"1 through 10","median_amount":13695.15,"10th_percentile":13695.15,"90th_percentile":13695.15},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"37","median_amount":1856.0,"10th_percentile":134.5,"90th_percentile":15031.03,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"124","median_amount":303.15,"10th_percentile":169.41,"90th_percentile":1713.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"637","median_amount":382.34,"10th_percentile":159.96,"90th_percentile":4233.29,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"42","median_amount":2344.96,"10th_percentile":489.27,"90th_percentile":7801.34},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"134","median_amount":313.42,"10th_percentile":165.32,"90th_percentile":1714.1,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"46","median_amount":207.58,"10th_percentile":77.42,"90th_percentile":6778.16,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":696.0,"10th_percentile":696.0,"90th_percentile":696.0},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"97","median_amount":1851.56,"10th_percentile":284.27,"90th_percentile":6366.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"47","median_amount":3065.86,"10th_percentile":607.69,"90th_percentile":18664.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"435","median_amount":1055.43,"10th_percentile":281.06,"90th_percentile":9235.54,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"138","median_amount":1201.23,"10th_percentile":316.34,"90th_percentile":2981.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":2376.63,"10th_percentile":894.96,"90th_percentile":26885.14,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"270","median_amount":1573.21,"10th_percentile":486.63,"90th_percentile":8547.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"30","median_amount":1131.71,"10th_percentile":607.06,"90th_percentile":6284.16,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"372","median_amount":3432.22,"10th_percentile":716.87,"90th_percentile":24126.91},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"1 through 10","median_amount":24007.79,"10th_percentile":24007.79,"90th_percentile":24007.79},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"45","median_amount":1011.49,"10th_percentile":300.29,"90th_percentile":13388.71,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"31","median_amount":3277.05,"10th_percentile":1744.93,"90th_percentile":35383.83,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"88","median_amount":898.53,"10th_percentile":274.63,"90th_percentile":2222.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"359","median_amount":1067.48,"10th_percentile":360.92,"90th_percentile":8975.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"144","median_amount":4382.43,"10th_percentile":843.0,"90th_percentile":55109.35},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"57","median_amount":1550.07,"10th_percentile":674.88,"90th_percentile":15105.71,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"111","median_amount":968.06,"10th_percentile":165.07,"90th_percentile":2662.26,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"121","median_amount":3604.84,"10th_percentile":1242.2,"90th_percentile":7806.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"26","median_amount":93257.52,"10th_percentile":18882.84,"90th_percentile":181890.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"118","median_amount":29561.29,"10th_percentile":3129.13,"90th_percentile":73139.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"35","median_amount":19701.57,"10th_percentile":2059.7,"90th_percentile":91625.76,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19624.19,"10th_percentile":8817.37,"90th_percentile":19624.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"90","median_amount":36733.84,"10th_percentile":2786.72,"90th_percentile":167228.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":47996.95,"10th_percentile":47996.95,"90th_percentile":47996.95,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"158","median_amount":61619.37,"10th_percentile":2135.95,"90th_percentile":254482.18},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"20","median_amount":105236.57,"10th_percentile":26189.35,"90th_percentile":232459.05,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"101","median_amount":15145.05,"10th_percentile":856.63,"90th_percentile":56641.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"21","median_amount":102442.72,"10th_percentile":33070.64,"90th_percentile":223124.24},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":37951.31,"10th_percentile":4685.4,"90th_percentile":109663.14,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":31237.41,"10th_percentile":3602.0,"90th_percentile":40063.36,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"52","median_amount":60308.24,"10th_percentile":1555.78,"90th_percentile":200399.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":311.76,"10th_percentile":200.0,"90th_percentile":845.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"47","median_amount":130.17,"10th_percentile":69.62,"90th_percentile":162.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"41","median_amount":237.31,"10th_percentile":167.31,"90th_percentile":252.31,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":177.02,"10th_percentile":177.02,"90th_percentile":236.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"40","median_amount":213.65,"10th_percentile":199.41,"90th_percentile":284.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":106.36,"10th_percentile":106.36,"90th_percentile":106.36,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"91","median_amount":325.56,"10th_percentile":95.99,"90th_percentile":372.81},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":304.64,"10th_percentile":262.4,"90th_percentile":3812.8,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"21","median_amount":315.59,"10th_percentile":236.42,"90th_percentile":371.28},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":162.78,"10th_percentile":162.78,"90th_percentile":162.78,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"12","median_amount":95.6,"10th_percentile":95.6,"90th_percentile":191.19,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"22","median_amount":346.4,"10th_percentile":277.12,"90th_percentile":380.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"12","median_amount":1147.08,"10th_percentile":640.0,"90th_percentile":1817.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"65","median_amount":300.15,"10th_percentile":230.76,"90th_percentile":491.03,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"37","median_amount":465.42,"10th_percentile":376.64,"90th_percentile":502.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":390.0,"10th_percentile":326.54,"90th_percentile":842.71,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"81","median_amount":566.97,"10th_percentile":425.23,"90th_percentile":566.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"46","median_amount":247.21,"10th_percentile":78.18,"90th_percentile":407.22,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"114","median_amount":800.2,"10th_percentile":192.67,"90th_percentile":1880.46},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":1077.6,"10th_percentile":800.0,"90th_percentile":1920.8,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":289.43,"10th_percentile":183.71,"90th_percentile":360.19,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":979.2,"10th_percentile":979.2,"90th_percentile":979.2},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"49","median_amount":309.66,"10th_percentile":247.18,"90th_percentile":422.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"16","median_amount":854.88,"10th_percentile":546.0,"90th_percentile":1333.02},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":323.98,"10th_percentile":300.27,"90th_percentile":323.98,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"93","median_amount":377.3,"10th_percentile":76.83,"90th_percentile":573.98,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"29","median_amount":998.72,"10th_percentile":558.07,"90th_percentile":1920.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":3332.8,"10th_percentile":2975.2,"90th_percentile":3782.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":482.8,"10th_percentile":441.46,"90th_percentile":552.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"20","median_amount":794.75,"10th_percentile":596.06,"90th_percentile":1357.86,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":743.49,"10th_percentile":743.49,"90th_percentile":743.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"55","median_amount":916.07,"10th_percentile":724.55,"90th_percentile":966.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":983.76,"10th_percentile":983.76,"90th_percentile":983.76,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"67","median_amount":2430.18,"10th_percentile":867.33,"90th_percentile":3738.94},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":2492.03,"10th_percentile":222.83,"90th_percentile":3335.4,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":468.61,"10th_percentile":368.61,"90th_percentile":559.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":559.78,"10th_percentile":327.95,"90th_percentile":643.92,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"11","median_amount":1641.9,"10th_percentile":1070.07,"90th_percentile":3551.8},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":552.04,"10th_percentile":552.04,"90th_percentile":552.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":1035.67,"10th_percentile":950.88,"90th_percentile":2173.89,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"12","median_amount":2291.84,"10th_percentile":1051.01,"90th_percentile":3332.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":3148.16,"10th_percentile":1798.97,"90th_percentile":4110.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"51","median_amount":964.98,"10th_percentile":846.47,"90th_percentile":1042.71,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"31","median_amount":1335.45,"10th_percentile":1162.75,"90th_percentile":1625.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":920.9,"10th_percentile":920.9,"90th_percentile":920.9,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"32","median_amount":1684.58,"10th_percentile":1365.19,"90th_percentile":1852.38,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"11","median_amount":979.59,"10th_percentile":874.13,"90th_percentile":1122.31,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"89","median_amount":3219.27,"10th_percentile":1276.0,"90th_percentile":4024.08},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":3288.32,"10th_percentile":3288.32,"90th_percentile":4110.4,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1013.74,"10th_percentile":890.26,"90th_percentile":1090.26,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":940.32,"10th_percentile":871.36,"90th_percentile":1069.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"17","median_amount":3039.07,"10th_percentile":1322.54,"90th_percentile":3648.84},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1058.51,"10th_percentile":1000.21,"90th_percentile":1058.51,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"36","median_amount":932.56,"10th_percentile":859.05,"90th_percentile":1032.79,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"24","median_amount":3155.2,"10th_percentile":1842.48,"90th_percentile":3998.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1600.0,"10th_percentile":1600.0,"90th_percentile":1600.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":42.88,"10th_percentile":42.88,"90th_percentile":42.88},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":253.72,"10th_percentile":60.0,"90th_percentile":362.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":61.78,"10th_percentile":47.12,"90th_percentile":435.84,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":95.79,"10th_percentile":71.84,"90th_percentile":478.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":80.65,"10th_percentile":80.65,"90th_percentile":80.65,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":108.15,"10th_percentile":81.11,"90th_percentile":417.84,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":54.59,"10th_percentile":54.59,"90th_percentile":176.82,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"58","median_amount":252.22,"10th_percentile":100.0,"90th_percentile":613.81},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":354.34,"10th_percentile":354.34,"90th_percentile":6064.8,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":296.45,"10th_percentile":144.93,"90th_percentile":26139.42,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"32","median_amount":100.0,"10th_percentile":50.87,"90th_percentile":746.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":161.11,"10th_percentile":149.06,"90th_percentile":29255.38},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":61.8,"10th_percentile":61.8,"90th_percentile":61.8,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"17","median_amount":56.41,"10th_percentile":53.66,"90th_percentile":2496.25,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"13","median_amount":265.6,"10th_percentile":194.4,"90th_percentile":1615.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":837.42,"10th_percentile":175.46,"90th_percentile":1469.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"59","median_amount":134.05,"10th_percentile":56.72,"90th_percentile":569.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"20","median_amount":265.34,"10th_percentile":155.9,"90th_percentile":1960.1,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":194.46,"10th_percentile":194.46,"90th_percentile":194.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"50","median_amount":332.4,"10th_percentile":176.02,"90th_percentile":737.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"11","median_amount":842.77,"10th_percentile":237.54,"90th_percentile":2231.99,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"68","median_amount":1154.37,"10th_percentile":252.97,"90th_percentile":7902.18},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":320.9,"10th_percentile":261.6,"90th_percentile":1944.18,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":136.51,"10th_percentile":118.13,"90th_percentile":602.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":174.07,"10th_percentile":110.41,"90th_percentile":759.17,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"28","median_amount":711.36,"10th_percentile":454.74,"90th_percentile":3228.18},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":162.46,"10th_percentile":134.11,"90th_percentile":465.57,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"34","median_amount":442.34,"10th_percentile":165.49,"90th_percentile":2407.91,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"21","median_amount":1084.13,"10th_percentile":605.28,"90th_percentile":3136.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Electronic Analysis of Devices","code_information":[{"code":"5741","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":3709.24,"10th_percentile":3709.24,"90th_percentile":3709.24},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":391.94,"10th_percentile":257.1,"90th_percentile":927.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":4914.3,"10th_percentile":2457.15,"90th_percentile":11255.63},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":255.76,"10th_percentile":255.76,"90th_percentile":255.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":99.14,"10th_percentile":20.58,"90th_percentile":388.11,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":543.6,"10th_percentile":543.6,"90th_percentile":3822.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":386.56,"10th_percentile":131.44,"90th_percentile":2356.92,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":1827.27,"10th_percentile":262.13,"90th_percentile":4669.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2279.4,"10th_percentile":2279.4,"90th_percentile":2279.4,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":1787.75,"10th_percentile":229.25,"90th_percentile":2006.68,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"35","median_amount":1182.65,"10th_percentile":236.53,"90th_percentile":5765.98},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":869.76,"10th_percentile":869.76,"90th_percentile":869.76,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":494.68,"10th_percentile":128.12,"90th_percentile":1319.68,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":532.38,"10th_percentile":220.6,"90th_percentile":1999.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":1628.34,"10th_percentile":1628.34,"90th_percentile":1628.34},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1965.0,"10th_percentile":1965.0,"90th_percentile":1965.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"13","median_amount":1123.2,"10th_percentile":241.6,"90th_percentile":7990.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":599.5,"10th_percentile":599.5,"90th_percentile":599.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":3077.42,"10th_percentile":3077.42,"90th_percentile":3077.42},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":698.13,"10th_percentile":698.13,"90th_percentile":698.13,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":680.82,"10th_percentile":680.82,"90th_percentile":680.82,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":4592.8,"10th_percentile":4592.8,"90th_percentile":4592.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":633.78,"10th_percentile":633.78,"90th_percentile":633.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":450.46,"10th_percentile":450.46,"90th_percentile":450.46,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":600.86,"10th_percentile":600.86,"90th_percentile":3532.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1013.82,"10th_percentile":745.4,"90th_percentile":1351.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":619.18,"10th_percentile":589.83,"90th_percentile":706.18,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":1572.09,"10th_percentile":319.0,"90th_percentile":4543.07},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":832.59,"10th_percentile":406.44,"90th_percentile":849.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":309.13,"10th_percentile":309.13,"90th_percentile":309.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":1938.56,"10th_percentile":1938.56,"90th_percentile":1938.56},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"11","median_amount":388.31,"10th_percentile":140.11,"90th_percentile":1246.25,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":1147.32,"10th_percentile":1147.32,"90th_percentile":1147.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"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":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":414.57,"10th_percentile":414.57,"90th_percentile":414.57,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":269.35,"10th_percentile":269.35,"90th_percentile":269.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":307.82,"10th_percentile":307.82,"90th_percentile":307.82,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":268.16,"10th_percentile":268.16,"90th_percentile":268.16,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":12.36,"10th_percentile":12.36,"90th_percentile":12.36,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Health and Behavior Services","code_information":[{"code":"5822","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":2113.43,"10th_percentile":2113.43,"90th_percentile":2113.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1250.39,"10th_percentile":923.52,"90th_percentile":3614.45,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6568.38,"10th_percentile":3199.98,"90th_percentile":23817.66,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":2158.0,"10th_percentile":2158.0,"90th_percentile":2158.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"14","median_amount":9581.47,"10th_percentile":3922.49,"90th_percentile":17480.92},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1126.19,"10th_percentile":20.6,"90th_percentile":2565.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Health and Behavior Services","code_information":[{"code":"5823","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"94","median_amount":352.1,"10th_percentile":195.2,"90th_percentile":536.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"102","median_amount":262.83,"10th_percentile":167.89,"90th_percentile":295.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"90","median_amount":390.19,"10th_percentile":259.1,"90th_percentile":501.38,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":260.0,"10th_percentile":129.35,"90th_percentile":356.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"201","median_amount":427.55,"10th_percentile":252.55,"90th_percentile":532.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"73","median_amount":191.21,"10th_percentile":136.46,"90th_percentile":262.86,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"374","median_amount":301.44,"10th_percentile":108.52,"90th_percentile":569.94},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"70","median_amount":160.1,"10th_percentile":91.47,"90th_percentile":246.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"19","median_amount":289.02,"10th_percentile":86.4,"90th_percentile":612.8,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":284.35,"10th_percentile":147.17,"90th_percentile":368.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":355.78,"10th_percentile":355.78,"90th_percentile":355.78},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"83","median_amount":206.32,"10th_percentile":132.3,"90th_percentile":281.5,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"42","median_amount":380.45,"10th_percentile":182.91,"90th_percentile":767.11},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"213","median_amount":225.22,"10th_percentile":150.0,"90th_percentile":296.55,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"58","median_amount":280.3,"10th_percentile":96.9,"90th_percentile":477.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Dental Procedures","code_information":[{"code":"5871","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":7892.67,"10th_percentile":7892.67,"90th_percentile":7892.67},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":7175.8,"10th_percentile":7175.8,"90th_percentile":7175.8,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"74","median_amount":173.44,"10th_percentile":80.0,"90th_percentile":1035.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"790","median_amount":190.81,"10th_percentile":125.63,"90th_percentile":479.72,"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":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"194","median_amount":288.96,"10th_percentile":163.0,"90th_percentile":692.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":228.97,"10th_percentile":137.06,"90th_percentile":558.56,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"360","median_amount":335.7,"10th_percentile":175.98,"90th_percentile":788.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"108","median_amount":105.57,"10th_percentile":34.41,"90th_percentile":155.91,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"511","median_amount":98.33,"10th_percentile":52.21,"90th_percentile":231.57},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"1 through 10","median_amount":105.16,"10th_percentile":105.16,"90th_percentile":105.16},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"56","median_amount":120.0,"10th_percentile":57.25,"90th_percentile":329.6,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"146","median_amount":221.61,"10th_percentile":128.1,"90th_percentile":541.89,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":180.99,"10th_percentile":180.99,"90th_percentile":180.99},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"678","median_amount":201.59,"10th_percentile":137.96,"90th_percentile":549.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"136","median_amount":212.14,"10th_percentile":89.0,"90th_percentile":875.04},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"100","median_amount":196.05,"10th_percentile":180.42,"90th_percentile":450.7,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"107","median_amount":71.33,"10th_percentile":44.47,"90th_percentile":173.9,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"186","median_amount":205.81,"10th_percentile":123.0,"90th_percentile":720.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"135","median_amount":200.5,"10th_percentile":68.4,"90th_percentile":601.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1260","median_amount":73.69,"10th_percentile":13.37,"90th_percentile":313.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"382","median_amount":75.67,"10th_percentile":16.37,"90th_percentile":342.79,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"142","median_amount":48.81,"10th_percentile":12.27,"90th_percentile":227.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1346","median_amount":77.5,"10th_percentile":16.12,"90th_percentile":335.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"41","median_amount":94.58,"10th_percentile":9.58,"90th_percentile":269.14,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1278","median_amount":201.13,"10th_percentile":66.57,"90th_percentile":547.46},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"1 through 10","median_amount":70.82,"10th_percentile":70.82,"90th_percentile":70.82},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"357","median_amount":198.4,"10th_percentile":71.68,"90th_percentile":480.8,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"492","median_amount":41.09,"10th_percentile":9.36,"90th_percentile":227.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"1 through 10","median_amount":779.28,"10th_percentile":65.45,"90th_percentile":71066.26},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"2199","median_amount":40.54,"10th_percentile":9.34,"90th_percentile":198.28,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"840","median_amount":204.1,"10th_percentile":49.92,"90th_percentile":539.76},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"13","median_amount":173.94,"10th_percentile":103.74,"90th_percentile":470.11,"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":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"183","median_amount":48.35,"10th_percentile":13.25,"90th_percentile":255.21,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"803","median_amount":44.11,"10th_percentile":11.36,"90th_percentile":176.25,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"367","median_amount":241.6,"10th_percentile":54.6,"90th_percentile":746.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"29","median_amount":327.04,"10th_percentile":92.35,"90th_percentile":1390.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"216","median_amount":180.61,"10th_percentile":52.08,"90th_percentile":628.6,"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":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"98","median_amount":382.11,"10th_percentile":118.0,"90th_percentile":1011.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":929.34,"10th_percentile":98.9,"90th_percentile":1573.53,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"163","median_amount":351.07,"10th_percentile":162.19,"90th_percentile":1317.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"49","median_amount":164.37,"10th_percentile":41.71,"90th_percentile":475.61,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"253","median_amount":785.87,"10th_percentile":159.78,"90th_percentile":3028.79},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"24","median_amount":516.0,"10th_percentile":136.0,"90th_percentile":2196.8,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"38","median_amount":338.62,"10th_percentile":92.05,"90th_percentile":822.35,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"148","median_amount":326.0,"10th_percentile":93.66,"90th_percentile":876.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"58","median_amount":829.18,"10th_percentile":132.6,"90th_percentile":3441.36},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":490.53,"10th_percentile":197.97,"90th_percentile":1015.24,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"152","median_amount":153.72,"10th_percentile":41.12,"90th_percentile":387.54,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"1 through 10","median_amount":6143.8,"10th_percentile":6143.8,"90th_percentile":6143.8},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"88","median_amount":970.4,"10th_percentile":147.2,"90th_percentile":3302.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"166","median_amount":499.2,"10th_percentile":489.6,"90th_percentile":560.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"858","median_amount":99.7,"10th_percentile":99.7,"90th_percentile":102.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"314","median_amount":154.61,"10th_percentile":154.61,"90th_percentile":159.13,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"50","median_amount":99.75,"10th_percentile":99.75,"90th_percentile":144.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"559","median_amount":174.56,"10th_percentile":174.56,"90th_percentile":179.66,"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":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":144.78,"10th_percentile":137.17,"90th_percentile":157.26,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1766","median_amount":488.72,"10th_percentile":488.72,"90th_percentile":548.24},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"1 through 10","median_amount":441.92,"10th_percentile":441.92,"90th_percentile":441.92},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"174","median_amount":499.2,"10th_percentile":499.2,"90th_percentile":560.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"135","median_amount":102.75,"10th_percentile":102.75,"90th_percentile":102.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"583","median_amount":102.65,"10th_percentile":102.65,"90th_percentile":105.65,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"448","median_amount":486.72,"10th_percentile":486.72,"90th_percentile":546.0},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"64","median_amount":99.75,"10th_percentile":99.75,"90th_percentile":102.66,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"63","median_amount":137.77,"10th_percentile":137.77,"90th_percentile":154.54,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"392","median_amount":499.2,"10th_percentile":499.2,"90th_percentile":560.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"1 through 10","median_amount":587.68,"10th_percentile":587.68,"90th_percentile":631.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":109.22,"10th_percentile":88.66,"90th_percentile":199.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":169.35,"10th_percentile":137.47,"90th_percentile":333.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":136.5,"10th_percentile":136.5,"90th_percentile":136.5,"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":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":191.21,"10th_percentile":155.21,"90th_percentile":284.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":126.88,"10th_percentile":126.88,"90th_percentile":126.88,"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":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"39","median_amount":617.95,"10th_percentile":470.71,"90th_percentile":693.14},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":150.87,"10th_percentile":150.87,"90th_percentile":150.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":428.8,"10th_percentile":428.8,"90th_percentile":428.8,"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":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":89.9,"10th_percentile":89.9,"90th_percentile":89.9,"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":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":112.43,"10th_percentile":91.26,"90th_percentile":250.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"1 through 10","median_amount":328.15,"10th_percentile":292.66,"90th_percentile":483.21},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":109.26,"10th_percentile":94.14,"90th_percentile":109.26,"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":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":195.39,"10th_percentile":195.39,"90th_percentile":239.47,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":504.96,"10th_percentile":415.94,"90th_percentile":646.92,"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":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":38.61,"10th_percentile":8.58,"90th_percentile":227.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"1 through 10","median_amount":141.57,"10th_percentile":102.12,"90th_percentile":643.08,"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":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":290.5,"10th_percentile":290.5,"90th_percentile":290.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":240.27,"10th_percentile":83.45,"90th_percentile":358.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":167.1,"10th_percentile":123.74,"90th_percentile":2378.39},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":39.13,"10th_percentile":39.13,"90th_percentile":39.13,"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":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":26.93,"10th_percentile":8.86,"90th_percentile":301.4,"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":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"1 through 10","median_amount":27.65,"10th_percentile":16.59,"90th_percentile":2437.5,"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":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"1 through 10","median_amount":126.4,"10th_percentile":126.4,"90th_percentile":126.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Influenza Vaccines & Pneumococcal Pneumonia Vaccines","code_information":[{"code":"N903","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":270.21,"10th_percentile":270.21,"90th_percentile":270.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Laboratory Fee Schedule: FEE SCHEDULE] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 25]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"1 through 10","median_amount":1284.45,"10th_percentile":1284.45,"90th_percentile":1284.45},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Radiology Bundle Employee","methodology":"other","standard_charge_algorithm":"[Radiology Fee Schedule: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Secure Health","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":70.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 80] [Observation (%BC): 80] [Emergency Department (%BC): 80] [Occupational Therapy (%BC): 80] [Physical Therapy (%BC): 80] [Respiratory Services/Therapy  (%BC): 80] [Speech Therapy (%BC): 80] [All Other OP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone marrow transplant","code_information":[{"code":"009","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyphema","code_information":[{"code":"043","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein ligation & stripping","code_information":[{"code":"119","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W Cc/Mcc Or Major Device","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O Cc/Mcc","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W Cc/Mcc","code_information":[{"code":"131","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"G.I. hemorrhage w CC","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":82824.74,"maximum":144943.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84481.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":120095.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":144943.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":85309.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86965.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":82824.74,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":41759.95,"maximum":73079.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42595.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":60551.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":73079.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43012.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43847.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":41759.95,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"No Longer Valid","code_information":[{"code":"214","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","code_information":[{"code":"222","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","code_information":[{"code":"223","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","code_information":[{"code":"224","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","code_information":[{"code":"225","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","code_information":[{"code":"226","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","code_information":[{"code":"227","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"248","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17724.32,"maximum":31017.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18078.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25700.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31017.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18256.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18610.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":17724.32,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Mcc","code_information":[{"code":"338","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Cc","code_information":[{"code":"339","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"340","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Mcc","code_information":[{"code":"341","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Cc","code_information":[{"code":"342","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"343","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":25161.78,"maximum":44033.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25665.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36484.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44033.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25916.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26419.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":25161.78,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":17666.52,"maximum":30916.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18019.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25616.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30916.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18196.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18549.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"fee schedule","standard_charge_dollar":17666.52,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Laparoscopy & Incisional Tubal Interruption","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endoscopic Tubal Interruption","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization & Radio-Implant, for Malignancy","code_information":[{"code":"363","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization Except for Malignancy","code_information":[{"code":"364","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures","code_information":[{"code":"365","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, female reproductive system w CC","code_information":[{"code":"366","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w CC","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & Non-Acute Leukemia w/o CC","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Childhood Mental Disorders","code_information":[{"code":"431","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning & toxic Effects of Drugs Age >17 w CC","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications of treatment w CC","code_information":[{"code":"452","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","code_information":[{"code":"484","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","code_information":[{"code":"490","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w/o CC/MCC","code_information":[{"code":"491","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient ischemia","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"527","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Proc w Pdx Hemorrhage","code_information":[{"code":"528","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular shunt procedures w CC","code_information":[{"code":"529","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures w/o CC","code_information":[{"code":"530","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w CC","code_information":[{"code":"531","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w/o CC","code_information":[{"code":"532","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","code_information":[{"code":"567","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","code_information":[{"code":"568","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small & Large Bowel Procedures w CC w Major Gi Dx","code_information":[{"code":"569","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Admit For Renal Dialysis","code_information":[{"code":"685","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W Cc/Mcc","code_information":[{"code":"691","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","code_information":[{"code":"692","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W Cc/Mcc","code_information":[{"code":"765","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W/O Cc/Mcc","code_information":[{"code":"766","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Sterilization &/Or D&C","code_information":[{"code":"767","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Complicating Diagnoses","code_information":[{"code":"774","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W/O Complicating Diagnoses","code_information":[{"code":"775","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ectopic Pregnancy","code_information":[{"code":"777","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Threatened Abortion","code_information":[{"code":"778","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"False Labor","code_information":[{"code":"780","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W Medical Complications","code_information":[{"code":"781","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W/O Medical Complications","code_information":[{"code":"782","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","code_information":[{"code":"984","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","code_information":[{"code":"985","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","code_information":[{"code":"986","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":78.32,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":70.82,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"First Health Network","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":85.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Maestro","plan_name":"Umr Employee","methodology":"percent of total billed charges","standard_charge_percentage":78.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"Va Ccn Government","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peachstate","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://dch.georgia.gov/providers/provider-types/hospital-providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[All Other IP (%BC): 80]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":80.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Qualified Health Plan (Qhp) Exchange","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 100000 | Total % of Charge: 70] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5400 Days: 4 Additional Days: 1650] [Normal vag. Del. 2 day stay-Case Rate: 2650 Days: 2 Additional Days: 1650] [Normal Newborn-Per Diem: 525] [Nursery  Level 1- Boarder-Per Diem: 1100] [Nursery  Level 2-Per Diem: 1500] [Nursery  Level 3-Per Diem: 2100] [Nursery  Level 4-NICU-Per Diem: 4000] [Rehab-Per Diem: 1100] [IP High Cost Drugs (%BC): 70] [IP Prosthetics/Implants/Devices (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Alliant","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 5027 Days: 4 Additional Days: 1534] [Normal vag. Del. 2 day stay-Case Rate: 2308 Days: 2 Additional Days: 1534] [Normal Newborn-Per Diem: 456] [Nursery  Level 1- Boarder-Per Diem: 1145] [Nursery  Level 2-Per Diem: 1439] [Nursery  Level 3-Per Diem: 1564] [Nursery  Level 4-NICU-Per Diem: 2004] [Rehab-Per Diem: 661]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Amerigroup","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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